24C-121 (4) //-r2Za:.2VC ..2
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CITY OF NORTHAMPTON
OFFICE OF THE INSPECTOR OF BUILDINGS
212 MAIN STREET APPLICATION FOR
NORTHAMPTON, MA. 01060 PLAN EXAMINATION AND
BUILDING PERMIT
IMPORTANT — Applicant to complete all items in sections: I, II, III, IV, and IX. O
�� C> T ZONING
LO .a...._ + a -` pp
AT ( CATION) .aDISTRICT []
LOCATION 'a°.) ISTeeETI
OF BETWEEN .._..... Awo....... ..
BUILDING ICSOSS STREET) (CROSS sTRctT)
OT
SUHO IV ISION LOT BLOCK SUE
V.
II. TYPE AND COST OF BUILDING — All applicants complete Parts A - D -I
A
A. TYPE OF IMPROVEMENT D. PROPOSED USE - For"wrecking" most recent use rn
re
1 ri N• ew building Re N d of Nonresidential
2..ddition(1/ residentiat. enter m
ober i One family 18 Fin Amusement, creational
of newhousing units added, if any,
in Part
, 13) 13o more family - Enter 19 Church, other religious
«IJJJnumber of nmu---- -s
20 I Parking
3 L.J Repair, (See 2 above) 14 L I Transient hotel, motel, 21 I I Parking garage
4I I Repair, replacement or dormitory - Enter number
5 r1 Wrecking(II.auf wiltsresidential, or units -en 22{ [ Service station, repair garage
writ
enter number of sin building in IS p Garage 23 I Hospital, institutional
Part D, 13J [ ) Car t 24 E f Office, bank, professional
6 _I Moving Delocatian) t6
T[..J Foundation only 17 LT, Other
- Specify... 25 nJ Public utility
26[J School, library, other educational
B. OWNERSHIP 27 EJ Stores,mercantile
8 in P• rivate (individual. corporation,
28 LJ Tanks, towers
nonprofit institution,etc.) 29 c20thef - Specify
9 U Public (Federal, State, or
Berl government) y 1X
'S
i ./�l /
C. COST (Omit cents) Nonresidential - Describe in detail proposed use of buildings, e.g., food
y,}� processing plant, machine shop, laundry building of hospital, elementary
10. Cost of o ovemen+ S yam. t ) school, secondary school, college, parochial school, parking garagetits.,
deportment store, rental office but?ding, office building m industrial plant.
To be ins! lied but not included If use of existing building
is being ahon ge d, enter proposed use.
inEe aboverose
e,.. Electrical
b. Plumbing _,
c.Healing, a r conditioning ,
d.Other(elevator, etc )
11. TOTAL COST OF IMPROVEMENT $
III. SELECTED CHARACTERISTICS OF BUILDING — For new buildings and additions, complete Parts E — L;
for wrecking, complete only Part J, for all others skip to IV.
--
E, PRINCIPAL TYPE OF FRAME G. TYPE OF SEWAGE DISPOSAL J. DIMENSIONS
30 L J M• ason. bearing) private campony Number of stories
Masonry(wall 40 Public or 49. Total square feet of floor area,
31 �}aaad frame 41 I Private (septic tank, etc.) all floors, based on exterior 1
32 r1 S• tructural steel dimensions
33 ..J Reinforced concrete H. TYPE OF WATER SUPPLY
50.
34{ ( Other - Specify 42 Li Public or private company Total and area, sq. fit ...........
431 I Private(well, cistern) K. NUMBER OF OFF-STREET
PARKING SPACES
F. PRINCIPAL TYPE OF HEATING FUEL I. TYPE OF MECHANICAL 51t Enclosed _
Will there be central air 52. Outdoors
36 I { Oil CO"cl'i'p"'"g' L. RESIDENTIAL BUILDINGS ONLY
37 Li Electricity 441 I Yes as[—I No 53. Number of bedrooms
38 7 Coal (( .—....._
391 1 Other- Specify Will there be an elevator? \ Full
54. Number of
461 I Yes 47[J No bathrooms
Partial
NOTES and Data — (For department use)
IY. IDENTIFICATION - To be completed by all applicants
Name Mailing address — Number, sewn/. city, and Star ZIP code Tel. No,
Ower or v/ i i.✓ ... _ _ C-hh
Lessee ./L
Y
rtir MIME
r rr. . s._ ...r _ ilt
.
3.
Engin er
..........
I hereby certify that the proposed work is authorized by the owner of record and that I have been authorized by the owner to
make this application as his authorized agent and we agree to conform to all applicable laws of this iurl sdi ction,
Signature of applicant // Addre_ pApplicetion dare
I 00 NOT WRITE BELOW THIS LINE
V. PLAN REVIEW RECORD - For office use
Plans Review Required Ch Pion Review Date Pions Date Pions
egui Check
Fee ie Started By _ Approved By Noes
BUILDING 1$
PLUMBING $
MECHANICAL $
ELECTRICAL $
OTHER
VI, ADDITIONAL PERMITS REQUIRED OR OTHER JURISDICTION APPROVALS
Date ote
Permit ar Approval Check Obtained Number By Permit or Approval Cheek Obtained Number By
BOILER PLUMBING MIN
CURB OR SIDEWALK CUT ROOFING
ELEVATOR SEWER •
ELECTRICAL SIGN OR BILLBOARD Ell
FURNACE STREET GRADES
GRADING USE OF PUBLIC AREAS
OIL BURNER WRECKING
OTHER OTHER
VII. VALIDATION
Building FOR DEPARTMENT USE ONLY
Permit number 4a/
Building n Use Group
Permit issued to A ✓ `�O 19„f
Building .7 / Fire G:oding
Permit Fee $ jo 00 ... Live Loading
Certificate of Occupancy $ Occupancy Load
Approved-t":
Drain Tile $ Cr' _L1��
Plan Review Fee $
TITLE
VIII. ZONING PLAN EXAMINERS NOTES
DISTRICT --- -"-"— -----
USE _ -
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FRDNT YARD
SIDE YARD
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SIDE YARD ---
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REAR YARD
NOTES _- -__
- For A ircant Use -:'tea '
X. SITE OR PLOT PLAN PP + '$ t-# �- ...-? —^.y.
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