16A-020 (2) -
IV. IDENTIFICATION — To be completed by all applicants
Name Mailing address — Number, street, city, and State ZIP code Tel. No.
1 t � r — / NOTES and Data — (For department use)
Owner or 71 .4,4 ) Fa.t :Dr..lck 'fG 1. FAIR "N �t i' LAC LE Q.` r ) A f CJ j 3 S g
Lessee
Builder's
2. SELL
License No.
Contractor
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.
Signature of applicant Address Application dote
�A.Z"f � t s'�f./ ��..! � . ' ✓`� rr< " ,�.4 --? t't k's' �- tr`- G/�r^r r Pi�� �r f4_ /4.
DO NOT WRITE BELOW THIS LINE
V. PLAN REVIEW RECORD — For office use
Plans Review Required Check Plan Review Dote Plans By Date Plans 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 Vf
Building � Use Group
Permit issued - 1 19
Building i / h O Fire Grading
Permit Fee $ 1' `[ - L (� 4 Live Loading
Certificate of Occupancy $ Occupancy Load
proved by:
Drain Tile $
-
Plan Review Fee $ /
TITLE
r CITY OF NORTHAMPTON
-”
VIII. ZONING PLAN EXAMINERS NOTES - A�` , . i
MASSACHUSETTS
DISTRICT 8.1; r. OFFICE of the INSPECTOR of BUILDINGS
4 „ Page / ? =-••� - - �' APPLICATION FOR
USE
INSPECTOR
J.' ZONING PERMIT AND
, O BUILDING PERMIT
FRONT YARD
z
IMPO 1 Applicant to complete all items in sections: 1, II, III, IV, and IX. 0
,y ZONING ,
P 01
�
SIDE YARD SIDE YARD I. AT (LOCATION) ! O 2 r.C( L.' -''1Ci' It GLAS c ^ DISTRICT �/ f`{ t
REAR YARD
LOCATION (NO.) (STREET)
OF BETWEEN AND
NOTES BUILDING CROSS STREET) CROSS STREET)
LOT
SUBDIVISION LOT BLOCK SIZE
N
II. TYPE AND COST OF BUILDING - All applicants complete Parts A - D xi
A. TYPE OF IMPROVEMENT D. PROPOSED USE — For "Wrecking" most recent use m
-4
1 I 1 New building R ritial Nonresidential
2 1 Addition (1/ residential, enter number 12 I, One family eA &C ' 18 I Amusement, recreational
of new housing units added, if any,
i n Part D, 13) 13 I Two or more family — Enter 19 L _ J Church, other religious
IX. SITE OR PLOT PLAN - For Applicant Use number of unit's— — — — -0- 20 L] Industrial
• 3 I)K Alteration (See 2 above) T
•hi ,
a -- iNNN •NN ■i 14 Transient hotel, motel,
_• •NNr• ■ •N• ■ •N .Na : . 7 . , , g P.-1 C' �.. � � T
._� 21 L Parking garage
: : : � • NN : N•r• _ : : : : : :. War :"."..."""Ni ::. i : 4 L-1 Repa ir, replacement or dormitory — Enter num
n • • rN ra N � ■ N Nw •• r:::::::11111 :::11:::::1 .6i:■• � / g 1 G ara g e . 23 I I ' = i Service station, repair g ara g e • �• • w • ■ ■ o units —0- .
aia :I :u Wrecking (Il rriultzJamily residential,
•a • { ■ : Hos ital, institutional •
•N . ..: ■ . Nw1r. S N i N■ ■ • ■ • • • • • • • ■ enter num o wilts in buildvi rn c P
11111:000:1111 . er■■•e ■a■a•awr• :: Part D, 13J
a ■■ Trios Z ! w •■ ••• ■� :N ■N sa•ruNN•: = •N• 6 Moving (relocation) 16 � _ . Carport 24 �f— Office, bank, professional
r • a 25 i Public utilit
• 17 Other — Speci /y y
es 0 w a � .. ■ 7 �� Foundation only I 1
i• N 1--...:::::::::;::::::::::: T: : � N• a■ • •NN • NNN : :: : :: : 26 l ) School, library, other educational
OM ee III" a: : •NwaN■ : ■
• ■ ` Y •. st w� t •; o t i r • ■■ iw .�.i ■.rr ■ :wrr ■rr■: :r. =•Q B. OWNERSHIP 27 � � Stores, mercantile
s a t • • • • • s ■ • • • • ■ • ■ • ■ w • r • 1 : a 3 •u: ::::i ■ ■r � •aii': Private (individual, corporation, 111 �r • • 1 ■ • 11 a• r : : K _ 29 j Other — Specify
• ■a : • •• • • r.•••••Nw •• •N _ $ : 8 nonprofit institution, etc.)
ft +�
!!� �� a y • u w ���•Diii�: r = NUaww•u••NU
9 l__i Public (Federal, State, or
2:90 • a.■iiN"7i iii +t � nil ::::: :: 3 :Nah : local government)
= a
t- .'-T'- • a - r i- 8: ••N •NN ...NN
� � +$.� •N ■ Na s a s • •• � • �� C. COST I (Omit cents) Nonresidential — Describe in detail proposed use of buildings, e.g., food
N }? • ... . •ss:: •: �:::■•a. : :. processing plant, machine shop, laundry building at hospital, elementary
! • ■ •�!•,,�! . !....: •�• N :N• school, secondary school, college, parochial school, parking garage for
' ; :i :i a:: a =� :::s :iiiiii : :: :alGiii : �••■N :wq _ N■ 10. Cost of improvement $ I G if �}
r N ' N r■N _NN q 1 department store, rental office building office building at Il plant.
�� • �� 'S:'�' •• : ... N ■N�N ■: : in the above cost To be installed but not included 1 If use of existing building is being charged, enter proposed
use. ustria
N •N • • N. • ■ iii ..- 1
N NN • r ■ :■_• ir• � , ::: i:: m : :: :::0: :: q : n :i ■_�::_ : : a. Electrical , ( /.. /J
r L ...H ..................... .. -r:::0 :lip ::
4,114Lity I f '1 � 1: :: :_ = aiiNi° Na =:ij• ■NN 1 w::::::::: :� �i uk •■ b. Plumbing :
r � iii- i N Na r: s
S.
* $ Iiii I s • . i • 1 i :i ' :'Z' Sr'ii i� • i • � =: :i: N•N ' :: • • _ _ _ • = N• c .
• ■ • N • • N N • ■• Heating, air conditionin g
lin { T : {r i. *f ••N••r•■a •:•r• r
��_■_ t {. NN• :: hilt` N:::L...■!L•aa.••• '• : : :::Z I'i d. Other (elevator, etc.)
:. :: mss: aa:R.■M.:N■ :. N•: •.•"N ■a 1 : •: : : : ::
• • a a , ■ �• a ••�■N.• aw . 111:111111116 :: 11. TOTAL COST OF IMPROVEMENT $ � 0 d
= : :Zt� : :�5: �«'�:. .....a.. :um:::::::::::::: III. SELECTED CHARACTERISTICS OF BUILDING - For new buildings and additions, complete Parts E - L;
• : ■ N ....NN ■N ■.• ar. a ■ ■ ■... ■•■ for wrecking, complete only Part J, for all others skip to IV.
Allitiligliii.-i e • s m :.. :•p':�: :: • a .. :.. a•
•=r • ••�. "'•" "" """"" "" "• .■N _ : ■.■■ E. PRINCIPAL TYPE OF FRAME G. TYPE OF SEWAGE DISPOSAL J. DIMENSIONS
_
• __ �a.�is :$ ..�t ... as$■ • ..N... ... . .. er _ 48. Number of stories
N..
• Nr : ::� •::::: N. rr •N• a: : :•N ••N: �: (wall bearing) Public or private company
��i . �� • N • � si�N• ■■a • . • ■ � :: : . r: • : ■ _� y g) 40 Li : __ : :: � � � ■ : :w ::• . • :NN N= ■•war =aaNr•a ■ • 30 � Masonry •• '.N 49. Total square feet of floor area, (�
a !�����i��II • : • � • � • • N• � •■ wua a Na Nwa • •
lULLLUi'i i■ r : a i N i N : • :N■■NN• • _ : _ 31 W fr ame 41 Private (septic tank, etc.) 3(l
• N• :: ::: • N • I all floors, based on exterior
N ■ • ::: :: i r • Nr . ■.
$I . ! a:: : N �■■ ■lri :•i�NN : a . :•:N:: 32 1 I Structural steel dimensions me" • - ..... : iia ,: : :ai: :•: : : :::::: :• a •NN :■rN • ■ :a : : ::• I H. TYPE OF WATER SUPPLY
$ Vi �n a =•a : is ■ : ••u• a•N•� :• :: : :: : : : : :: : : :.su. w :• aN : : : : ::: : :: :: :NNr 33 Reinforced concrete
a + �:l::i ; luie 11:141.... 4. •••• •a� •: ::: : : : 1 p /y I P P Y 50. Total land area, sq. ft-
� N NN ::: a 34 Other — S ect - 42 Public or private company _
14 $ 11 � � ••
;. : * 11:::• : :::1s : :ass:::::::: 1: :as : : :: :: ::s::: N• 43 ❑ Private (well, cistern) K. NUMBER OF OFF STREET
ii is $ ' + :: •. . : :• ■ 1::::: II :'
% + • { $ '� • : :iii::ii:'1 1'1'11 : ::: ::1 �1t :: 11:11 :•�' . PARKING SPACES
tif ■a• •
. # { t ' $ ; : r ' 4%4,...,4- • $ � ; ... $ 1 s : : : 1 �1 : :s: : 1 :sssis. .us. : 11 51. Enclosed
t , +. 2: t .« , .. $ f + i 1.- } +., • + • . • 11 :a `:a '. ■ : el a n i r : :a'� :lll MS : : : :: •ar F. PRINCIPAL TYPE OF HEATING FUEL I. TYPE OF MECHANICAL
ir( t }. trr • , N ■• : :a•••a ■a •...■ ••• : : 35 I Gas Will there be central air 52. Outdoors
+ $ ++ ttt_ Z +- ± t t +.+ + «$ t � • ii • iili i = r :11:: : conditioning?
i = :11111■•a
t_;<:f )t t + -.t.. -+4' * *4 + r r t 1+tr t f- , UM �i i iii
iiiliiliiifiiii itiiiiS •: ■ • :111 =:::i contonin
t f t } + ) <c , +r,it} + 27* , ,, t+ T' •w m■• • Nr : 36 Oil
:T.; « r + ! s
, ,i1 + , d' I t {Y' S +I .j ja $i r 4 -t 1 I/1144 tt} - t+ + �' " * ++ 1: - }t + i } i t.= ++ a : �: i i:a j : :: : :N■ : ::: u I g L. RESIDENTIAL BUILDINGS ONLY
+ r . tt «t t t + {{ Fat tt +' # R t = ills i iiiGi ak ii N : : :a:N : :: :• :.NN. Li -- 53. Number of bedrooms
I « f $ . j, ■ • : • •• • N • 37 j Electricity 44 Yes 45 No
t t rt t t i gg � w wN •.
i r t t. t t 11 2I; t- , f .1 : 1 -.+ + I t } " 1 t I i, J «+ r l • { 1 $ f . a= : :si E i : a ra ■.: : 38 1 J Coal
• ..-r t� +trF t f r 1 + t � �: ::a :in:• i �■ t : :•••
.w<� }+-+-«Y rt« -t r r rt t- itt+ , { _ t .. : • a• .• •. •NN■■
o
.. + 3 Li Other — Specify Will there be an elevator Full
p��Np� N ���� •• • •NN r••• N.N p IY
f r` tt. S�!!!!!!!! �!!! �ll �! Lr!!•i: �a :1��i'�:>��¢�!�!1•ii:1rNlN•1 :� 54. Number of
46 T 1 , Yes 47 ' No bathrooms
Partial
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