10D-030 (12) IV. IDENTIFICATION — To be completed by all applicants
Name Mailing address - Number, street, city, and Stan- ZIP code Tel. No.
1. ,� � guir _ 8 , : \ o f . i.. �! oi s�o /T NOTES and Data - (For deportment use)
Owner or
Lessee e k � ,. ; I✓ l' - 111 7Cs - oz31 1
2. �� • S .Q.,A.�/ 1 — . '.._ Builder's
License No.
Contractor `� • . ; I '- Din 6
3.
Architect or
Engineer
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 jurisdiction.
Si•n•,ure of applicant Address Application date
DO NOT WRITE BELOW THIS LINE
V. PLAN REVIEW RECORD - For office use
Plans Review Required Check Plan Review Date Plans By Date Pions By Notes
9 Fee By Approved
BUILDING $
PLUMBING $
MECHANICAL $
ELECTRICAL $
OTHER $
VI. ADDITIONAL PERMITS REQUIRED OR OTHER JURISDICTION APPROVALS
Permit or Approval Check Obtained Number By Permit or Approval Check Obtained Number By
BOILER PLUMBING
CURB OR SIDEWALK CUT ROOFING
ELEVATOR SEWER
ELECTRICAL SIGN OR BILLBOARD
FURNACE STREET GRADES
GRADING USE OF PUBLIC AREAS
OIL BURNER WRECKING
OTHER OTHER .
VII. VALIDATION
Building FOR DEPARTMENT USE ONLY
Permit number
Building. . Use Group
Permit issued ! 7.1 )& ri 19_ �
Building Fire Groding
Permit Fee $ / 9/ • (,\O Live Loading
Certificate of Occupancy $ occupanc Load _
Approved by:
�
Drain Tile $ � e c,441 f 54,,-4:e4.
Plan Review Fee $
TITLE
`g CITY OF NORTHAMPTON
VIII. ZONING PLAN EXAMINERS NOTES MASSACHUSETTS
i
'....*.;g , . - OFFICE of the INSPECTOR of BUILD ,INGS
DISTRICT � ' r- Page,Cl� 4 /� ^. Plot ( ' % , � APPLICATION FOR
USE _ ZONING PERMIT AND
INSPECTOR BUILDING PERMIT
FRONT YARD z
IMPORTANT — Applicant to complete all items in sections: 1 11, 111, IV, and IX 0
SIDE YARD SIDE YARD t _ 0
1. AT (LOCATION) -./ . �,�I'�� � �, �! - ; STRICT ti. R., 4
REAR YARD LOCATION (NO.) (STREET) ` 111 OF BETWEEN AND
•
NOTES BUI LDING (CROSS STREET) (CROSS STREET)
LOT
SUBDIVISION LOT BLOCK SIZE
N
II. TYPE AND COST OF BUILDING — Al! applicants complete Parts A — D -1
A. TYPE OF IMPROVEMENT D. PROPOSE U SE — For "Wreckin most recent use m
1 New building Residential Nonresidential
. 3
2 1 I Addition (1/ residential, enter number 12 I One family 18 Amusement, recreational
of new housing units added, if any,
IX. SITE OR PLOT PLAN — For Applicant Use in Part D, 13) 13 ['WO or more family — Enter i / 19 Church, other religious
PP number of units— — — — --> I /
3 I I Alterotion (See 2 above) 20 Industrial
: : ter= 4 Repair, 14 I I Transient hotel, motel, 21 parking garage
.•f I RP ir, re l P acement or dormitory — Enter number
woo: .iaa • u .
.• ..
..
�• : 5 Li Wrecking (11 multifamily residential, of units 22 Service station, repair garage
—
NN■oNN■ ■NN•.aN..NNNffeN•. enter number of units in building in 15 [ arage 23 Hospital, institutional
.! •• : _ .••.NN ::: • _ : a•f.
: I P a rt D , 13) 16 Carport 24 Office, bank, professional
N .� 6 LJ Moving (relocotion)
uSN: NNN• . ::: :ai•:s * •: :
: r _ a• 17 I 1 Other — Specify 25 Public utility
reamasONI•: :::: _ 7 I ) Foundation only
:. NNNe . : 26 I School, library, other educational
:::::::::i:: w�iaa•Zi.. r.�.s: = o euese a : L B. OWNERSHIP
27 Stores, mercantile
:: : :!::2 •NN* •.s....:ria■:re.e.c : as • ; 8 Private (individual, corporation, zs I Tanks, towers
.N..a
:• ua•••NN..•■f.a non rofit institution, etc.)
• _ w 29 Other — Specify
••f • . SOMA : 9 I I Public (Federal, State, or
•5..Ze : . .:.a .: : : ::: local government)
a....
.....Yi : .N NN f :N :
:: •wa. :: N• le::: e: : C. COST (Omit cents) Nonresidential — Describe in detail proposed use of buildings, e.g., food
•f ■N : : .: processing plant, machine shop, laundry building at hospital, elementary
w:: :: :N.•. O • .N :....a N••.a• a■..NN
_,. a =w • .aN
= 10. Cost of improvement $ school, secondary school, college, parochial school, parking garage for,
ff...N ..f■e.N..N.a MIIII Of•f de p artment store, rental office buildin g, office building at industrial plant.
, g
... :N
N •°•.•• =N= : : : To be installed but not included If use of existing building is being changed, enter proposed use.
=•N.•anw in the above cost
...N.a.•N r ..f _
.
: :::: ::�:.fa� . : .. a. Electrical
tr OOOOOOO MI: fs...... :::: : Gi:: :::i :: : ::: _ � •
111111 b. Plumbing
:: _
uj: U5US5e =�__ : = NN . : � ° s. is =: : = =• c. Heating, air conditioning
.Ns. : :■..5i .. :..
:::z i::•• N:•• •p. .N : "f d. Other (elevator, etc.)
Nf .Ni::.a .. :. •.•: ...
s�:
:u•.•N....ss.. : s
.S.
f• ia •s••••e: : :: • : • :::.
•s::::: :::: : _ i..af•a : ' 11. TOTAL COST OF IMPROVEMENT $4 1 . 1/ 000
.r : w.:: a.. :. :::: :::: fa ep eMi
:: ..s. s s O::•. a a fNf.. a�� . III. SELECTED CHARACTERISTICS OF BUILDING — For new buildings and additions, complete Parts E — L;
5.... : :ii ::.. :i::::i::::i:: :ii• _ __ _ :
:: 1....::!::::: for wrecking, complete only Part J, for all others skip to IV.
:i:: ::. •r
i = a:: =•: :S*s.Ss5:::! a auN aNs : ::: E. PRINCIPAL TYPE OF FRAME G. TYPE OF SEWAGE DISPOSAL J. DIMENSIONS
:r..: :f.. :•: :S •.•.•..• : : :
. ff• ::::::......::: :: `� 30 1 Masonry 48. Number of stories
. :•..: :•..ffr :••a. =aaa:i : :.: I y (wall bearing) 40 ublic or private company
��g Z a �S::ii: ::i:: aaa ��.� =•a• •N ; a 49. Total square feet of floor area,
s : 31 Wood fra 41 Private (septic tank, etc.)
::r:
. :a�:::i::: =irwr • w a r :f • r.r :
all floors, based on exterior
•i:: ::i `: : .:s• i N■ .• NN;.:Nj.N■i
i i::: : : :: : ::w : : : : :: eaannuur .5.•a = •• : •1i. 55 • S .: : : :: : =•• = :Ne
: •.• ••••: •
i 32 1 Structural steel dimensions
2::!: w r:Ziu N ■ a■ • • : oa : r' 33 1 Reinforced concrete H. TYPE OF WATER SUPPLY
::::::..:::::...:1141... i S �_�i 5 ::a ••••.. :a••••a.• a ....f•.N :...a:.a:.s WWII
�i:: : ::::::i :: :: SasS • . .. ...•: : 55. : 50. Total land area, sq. ft.
i:
:wa:: is a.:I�i•i.::: :::ui:: • ..
• . N • •••• __. : 34 1 1 Other — Specify 42 r ublic or private _
■.•r 5f .• rr i i :s rivate company
K. NUMBER OF OFF- STREET
• •tiff • ■: •
:sm�ssf• • : N. a f = .•• : =i �fi
: •a ■•• : :: : •• •• : 43 I I Private (well, cistern)
• • ■ • • N • • • N : ::: : : ::u:•• N PARKING SPACES
::::�asss:s 'i $ ass :as =::wa' a s a s:s::s sa•ai�s ;:s :•
• • :121 :••: : : 111:1: .•••5555 ra N •.a. .N..••r.a. •■.
■ i=s _$ $�
is aas` �••• $ s s s•s a ' s = 5.. 41:11:::::::111 .....s.s 51. Enclosed
it
..• f•..ff • ...... .......• • •• r = t F. PRINCIPAL TYPE OF HEATING FUEL I. TYPE OF MECHANICAL
a .s :�• � g : :: •i N • :N •552 : :: i• SN. • � N rN N•N.s...5.■N f:aN:
: : :.s : u 11:B : 3 . i :: " :a :i : :sZiiss1ii� := .
•� :a...u...
35 I I Gos Will there be central air 52. Outdoors j
�•N .• ■ N • ! conditioning
, • �� a. : i ff • : : : ::: :S::s::iwii . :: 36 0 g L. RESIDENTIAL BUILDINGS ONLY
r :s isi: w ::: :i rs z � �(�/
• es + + :• • • • oN au 37 E lectncit 44 Yes 45 No
ss s : �:s.i ::: :: ww :� s: :a:::f: s :s s Li a + r •• Nu .2555 N N•N• y 53. Number of bedrooms
t $ i .iii iiii i � ; i 3 i 'i� $ Y + , , ' • a +
a • ai- ..•� a�zspw� :si$ :i
� : •. ■ .:••s ' 38 Coal
�' ♦ ` marsaa" � . •� ' I s N Le mma :1z: e.•4• :1: ■• � • : ■. : �J /
i
r ...•, _ Pua::: #u ; :�tm K•_ , , . i=a _ r ei , urinimum es • f __ N• _ 39 Li Other — Specify Will there be an elevator' Full
I 744:: 54. Number of
46 l_ J Yes 47 bathrooms /
• � Partial `