10D-030 (4) ,
IV. IDENTIFICATION - To be completed by all applicants
Nom , addr – Wi ther, street,, rtv, am to A ZIP code Tel. No.
1. erN'111 . - � 38 : `j Iff ,• 10/64 / - r NOTES and Data - (For department use) • Owner or � `o. U � % a L.3 �-
Lessee �G C , C�F�/ 410 � ♦ License No. ... - - (3 k -� '�- (,i 1 \�: i it " k s C._..
Contractor D/ /a/
3. J (C
Architect or � /60 —
Engineer f6Y•
1 hereby certify that the proposed work is authorized by the owner of record and that I have been authorized by the owner to l
make this application as his authorized agent and we agree to conform to all applicable laws of this jurisdiction.
Signa re of applicant Address Application date j, f
SIR_ i r & c.k.-
DO NOT WRITE BELOW THIS LINE
i do
V. PLAN REVIEW RECORD - For office use /4 /
Plans Review Required Check Plan Review Date Plans B Date Plans B Notes A (0 C `-
9 Fee Started y Approved y
BUILDING $ 74;4 9 CO
PLUMBING $
MECHANICAL $ AK i' C 0
ELECTRICAL. $ • 1 - Cili, ^ re"' �,
OTHER $ /tI 6 C a
VI. ADDITIONAL PERMITS REQUIRED OR OTHER JURISDICTION APPROVALS 0
Date Permit or Approval Check Obtained Number By Permit or Approval Check Obtained Number By
BOILER PLUMBING
CURB OR SIDEWALK CUT ROOFING (I:3 . _ (
ELEVATOR SEWER *� � ,
ELECTRICAL SIGN OR BILLBOARD /
FURNACE STREET GRADES Z))6`
GRADING USE OF PUBLIC AREAS
OIL BURNER WRECKING g % J1
OTHER OTHER f► O 4
VII. VALIDATION
Building FOR DEPARTMENT USE ONLY
Permit number
Building . G U G -
Permit issued LL tD 19 Use roup
Building Fire Groding
Permit Fee $ a cIc D ' i Live Loading
Certificate of Occupancy $ Occupancy Load
Ap •roved by:
Drain Tile $
/,
Plan Review Fee $
TITLE
� - .� ,. CITY OF NORTHAMPTON
VIII. ZONING PLAN EXAMINERS NOTES MASSACHUSETTS
�
AR C w J 4 ' "!i
�'c., " ra OFFICE of the INSPECTOR of BUILDINGS
rdli DISTRICT j� /ei0 stl( /
. ,. Page Plot � d• �� �� APPLICATION FOR
USE ��
INSPECTOR ZONING PERMIT AND
BUILDING PERMIT
FRONT YARD
Z
IMPORTANT — Applicant to complete all items in sectio•s: 1, 11, 111 IV, • d IX. 0
SIDE YARD SIDE YARD ' P t i ► '>.�fl.'�� R I� ��aM I % ZONING ! n
I• AT (LOCATION) .�.�t_ •
.� , ��.. /�-- - DISTRIC /44
REAR YARD LOCATION (No.) (sTR )
OF BETWEEN AND
BUI LDING (CROSS STREET) (CROSS STREET)
NOTES LOT
SUBDIVISION LOT BLOCK SIZE
V►
II. TYPE AND COST OF BUILDING — All applicants complete Parts A — D
A. TYPE OF IMPROVEMENT D. PROPOSED USE — For "Wrecking" most recent use m
—
1 rlew building Residential Nonresidential
2 1 1 Addition (If residential, enter number 12 1 I One family 18 Amusement, recreational
of new housing units added, if any,
IX. SITE OR PLOT PLAN — For A licant Use in Part D , 13)
nu 13 `'r or more family — Enter ) 1 19 Church, other religious
pp number of units— — — — -i■ 20 1 Industrial
3 I Alteration (See 2 above)
_ : 14 I 1 Transient hotel, motel, 21 I Parking garage
= r 4 1 Repair, replacement or dormitory — Enter number
:
: : ' of units — .--� 22 I Service station, repair garage
_ ■ :Z :: 5 1 I Wrecking (II multifamily residential,
enter number of units in building in 15 " Garage 23 1 Hospital, institutional
..a
.ass ••s : Part D, 13) 16 I Carport
w 24 1 Office, bank, professional
u.r■rrs■s•.■MO: 6 1 Moving (relocation) 25 1 Public utility
_ _ • S 17 � 1 Other — Specify
= 7 I I Foundation only 26 F1 School, library, other educational
: =: ° .euSSSSSSSsus.: B
•S B. OWNERSHIP
■ ■• ■_ ■. 27 1 Stores, mercantile
■ : : Srr : 8 [ "Private (individual, corporation, 28 I Tanks, towers
• :: elm. nonprofit institution, etc.) 29 1 Other — Specify
:5::. :MO 9 I 1 Public (Federal, State, or
■ ■ ■
!SOMA . a • e a . . .easeessN.0 : local g overnment)
e ■ = : :r•••: C. COST (Omit cents) Nonresidential — Describe in detail proposed use of buildings, e.g., food
processing plant, machine shop, laundry building at hospital, elementary
s= _::: 10. Cost of improvement $ school, secondary school, college, parochial school, parking garage for,
.esuaa ■••asaeaeeea.■seem. department store, rental office building, office building at industrial plant.
=reeeeeesif : : : To be installed but not included If use of existing building is being changed, enter proposed use.
in the above cost
N• ■aea ��
.... . • .r ua• = se a. Electrical / 3
u•su aa S. : ; •• o /iie, r 1 - � A.�l i .li� �tlt_! ,? / ne,„7, '/ X77)
u .eu•N 5::: sr•u: • _� ° b. Plumbing
e■ _
�:•.S =eee ... :S : c. Heating, air conditioning c , /
eeme. : • ::: tree•: ,� E'.. j _ ie �-6)-
•u■ d. Other (elevator, etc. ` ��OV D
.ea .
■. ■ra.N. ■■•::: :: : : '
■ 11. TOTAL COST OF IMPROVEMENT
....a:. _ e::::: ::: ::: III. SELECTED CHARACTERISTICS OF BUILDING — For new buildings and additions, complete Parts E — L;
MU: MU: 1: e
see.= : 1 =• for wrecking, complete only Part J, for all others skip to IV.
_ : _ :.... : : : :::: :i: E. PRINCIPAL TYPE OF FRAME G. TYPE OF SEWAGE DISPOSAL J. DIMENSIONS
s .eN
= 48. Number of stories
_ _. : 30 I 1 Masonry (wall bearing) 40 Public or private company
•s." "tSaau• :::::: a:rri ::::••r. i 49. Total square feet of floor area,
.. : •: 31 rood frame 41 I I Private (septic tank, etc.)
u all floors, based on exterior
'�S:oi: : : ::: : ::: : •..,•.{•••.r : :te: : i• ■■.: 32 [ 1 Structural steel dimensions
■r
: :S:e: : ■i:::• ■ a. •_
�
:: :Sa Of : = a ■ :
q : :: : ::ubosO:OO �r : _ =ius • ■■ • • 50. Total land area, sq. ft.
i d: i i ::::: ::: :: _ : . : a ■ :: ::: • _ _ __ = 34 I I O ther — S pecify 4 2 public or private company _
S S: : :US •r ■a:• r
:.:•:r. N : : :■ • 43 Private (well, cist
u :::_• • • .. ....••• : •.• :•r• r•: Sa• ': : ss = I I ) K . NUMBER OF OFF- STREET
�i r s PARKING SPACES
e7r=:::ia •�::•a: =� a: i .S : i :: ::i:::::::: _ _ ■a: : : r' 51. Enclosed
a • • • :: : = ■ • =:::i • •s ■■ a : • :u: : : :SSSS : 1
::Sa: S•S S•ii�t� _ S� p a Si ■•s�' r• Si�e: S�i� a .. • • •I F PRINCIPAL TYPE OF HEATING FUEL I. TYPE OF MECHANICAL
:s.e■•r rs 'i.1iSiaa .ea : r isSS91:.: M iSr � ir • . • . Siiir1s3: =1iiSus.asNO■••a■N : :• :':::i ::i S : :■: t
• :H .. . r• :r:: : : : : i:s Nr ....= .u . . N
a NNN■■■ ss pp== . ■s m • : e .:::::::::::::::::::::pp,--::::::::::- u :: :•N:
35 1 Gas Will there be central air 52. Outdoors
�r as � b S. . ■ r.■r$rSra•i:i . r :i ::ie :
. :aa:: ::•:: rr • g .. : S S:S s::a: S y SSSSa : : ::�..: : _ _
+,x a a� i .a:: i s� s � ,. + +� : • r •• ��■ r � =: : :S�......SS:� :p. •. .... Neu :: •a.eNS' 1
�+� I conditoning L. RESIDENTIAL BUILDINGS ONLY
$ "' : :S : .s... ■a :: :::S: S�a .= a i Niiii ii ieii i. s :•: : :S .: 37 I Electricity 44 L Yes 45 i No
���� � $ ■ u u Sa • u.re 39 Other — Specify Will there be an elevator` 53. Number of bedrooms eimposife sod ) j • 1? Pr : d �� i •1 � : .� • a . a ' ....nu! µ$ • • ra sp i S • ■ ' .e is.. ... ...a : :: : ..a •••••.ssea. 38 coal azi
t y lsss ■es■••■e■.■!•e•■tf` -lei!! •u ■ • � ! s[ll�!!•S :Nr� :S�S: ::S :•S :� :S : Yr Full
�--���' 54. Number of
46 L l Yes 47 L_T'ro bathrooms
Partial
P I•f'I P