16A-020 IV. IDENTIFICATION - To be completed by all applicants
Name Mailing address - Number, stmt, city, and State ZIP code Tel. No.
NOTES and Data - (For department use)
Owner or )
L
Builder's
2.
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 date
,k�- L 0 X03 ue "`�c t'.Cace. — xee. c� d- l 11 I g7
DO OT WRITE BELOW THIS LINE
V. PLAN REVIEW RECORD - For office use
Plans Review Required Check Plan Review Date Plans By Date Plans By Notes
Fee Started Approved
BUILDING $ •
PLUMBING $ '
MECHANICAL $
ELECTRICAL $
OTHER $
VI. ADDITIONAL PERMITS REQUIRED OR OTHER JURISDICTION APPROVALS
Date ate
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
7
Permit number 1 1 � r ftt
Building Use Group
Permit issued * ,v00. - 1, 19 Fire Grading
Building
Permit Fee $ 10 no Live Loading
Certificate of Occupancy $ Occupancy Load
$ Approved by:
Drain Tile 944,7241 t w
��' J 1
Plan Review Fee $
TITLE
<01'1'1:140 - CITY OF NORTHAMPTON
VIII. ZONING PLAN EXAMINERS NOTES . MASSACHUSETTS
*., "el• OFFICE of the INSPECTOR of BUILDINGS
DISTRICT ` ��J �
. v �
' 1, Page I i Plo - 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 1. O
SIDE YARD SIDE YARD . ti � ... � � ZONING ' - )
I. AT (LDCATIOP) `. . l h t ' L ; ∎ ��_ /--'' ( r ' .- / ., n
DISTRICT ii (
REAR YARD LOCATION N0.) (STRE
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 -1
A. TYPE OF IMPROVEMENT D. PROPOSED USE – For "Wrecking" most recent use m
-
1 U New building Residential Nonresidential 1
2 Addition (If residential, enter number 12 l One family 18 1 I Amusement, recreotional
o/ new housing units added, if any, I
IX. SITE OR PLOT PLAN - For Applicant Use in Part D. 13) 13 1 1 Two or more family – Enter 19 LJ Church, other religious
PP number of units– – – – -->
0 3 N Alteration (See 2 above) 20 LL Industrial
• :ewer : 4 Li Repair, replacement 14 1 I Transient hotel, motel, 21 El Parking garage
lrNNN w w �_�tr •� r:* r • ■• • ■■ P P or dormitory – Enter number
..N■! l! ff .= N rr
' • r • N * p. : •ara r•x • rN•r Nrx 5 :umasse: I 2 2 L i Service station, repair garage
.....
Joe ma' : _ : ■ N,r •: : 1 Wrecking (if multifamily residential, of units – –0- I
b rr: :: : :::■ : enter number of units in building in 15 L–J Garage 23 LJ Hospital, institutional
:1:,:::: _ : ■ ■: • : P art D, 13)
:::::::::: :••x: : ;N•xr: :::::: anal:: ••: : 16 1 I Carport 24 r] Office, bank, professional
s.......s : r :• N 6 Li Moving (relocation) -
: ! : _ : [ � p / 25 LJ Public utility
N• 17 Other – Specify y Y
: : : : : : : : : :: i■= : ::�• ..... : : :: _ r . : 7 1 1 Foundation only )
e � ::� :. :•rp••• : • � • � j2 :: : ' •• r ••Z ...... ::� ■,N ■N ■• :•N,Nr ■ S� Srr �' .. 26 r� School, library, 1 :11•• •:■ r _ _/'0 I y, other educational iihist, : :N : a•N :x. :•a �: lrr B. OWNERSHIP ( �
■■ ■: :r • •. • • •r WOE 27 Stores, mercantile
...... : 1�ir = = : : : : : _:: : ::::1 is: ii 1:::!:a :MUM
28 1 1 Tanks, towers
•r•r E61:*a'•':• :ls : :n:::■.NxN•xNN••r■■ 8 Private (individual, corporation, 1 r
: :::: :Na • a at.: : nonprofit institution, etc.) 29 Li Other – Specify
::r :•: :1..: : : :: :::::::::"1 : i••
: : :: ::OOruN
rN :: 9 1 1 Public (Federal, State, or
�� N. • r■ ■• ■::: ::::: •
:o:• :ru•:ra : : ::. ' '••: :::::u:i "' : local government)
:: •:: ••: :: �r•N■:�ir ::: : C. COST (Omit cents) Nonresidential – Describe in detail proposed use of buildings, e.g., food
. ::r■■■ N! = • ■■ NN : : :r■ ....s =• :N•N: =i:...... : : - processing plant, machine shop, laundry building at hospital, elementary
• p p garage .N• N:.:xr: Nxx
rruNNlx::••xuuxxNNNN ■ • - school, secondary school, college, parochial school, parking ara a for,
ee.0 OOOOO r x ' : =lrr ■• : :rrx :r � , ■ : ■ � 10. Cost of improvement $ department store, rental office building, office building at industrial plant.
.•r.u. '1.� = ==':: :rrr■=ii = : : : :' : : :l : :i•a: :mil::: � : ! : :Pi : To be installed but not included If use of existing building is being changed, enter proposed use.
P
e••.•!••.'.. ' _ ��
as■ _ : : : : :: i• "= �� iii : above cost
:: 2 a. Electcal
r■ • :wr•••Nr ■ ■NN•N•i1 : •■
..::::::: :::::::�, ::! " = :i : ::: : ::: : : :i =' It tint : r • ii b. Plumbing
_ : r• :_ :l : : :rN • : :: ! • :■ __ r rx:••'•:•: : _ : ■= c. Heating, air conditioning
f::::ll :s:: • :':NrrlNr :* : : : : -• •:. :
.•. r • r
: : : :: • x. r•rN
=r ■ :�i: : :l :a • :=i:a : : : :�1 l =••• o... : : = d. Other (elevator, etc.)
N■ ...:: ::o : : ::, :: ::::1Ti
• ::=a t lid • r 8:61: ::: : ::C :::::: N :N :• a : : :•: '_ '
:■ 11. TOTAL COST OF IMPROVEMENT $
n : 1 r : ::: : . :... u E'■ s =
!!:a ;'. •• s�.s :.� ::::!! !:l:si:::lt !..; : III. SELECTED CHARACTERISTICS OF BUILDING — For new buildings and additions, complete Parts E - L;
x •NxN .•
:= ■■ a : : ::: :12 : „s:iis�'s�ii11:41s "s i :::: ::: :: : : : : :: s•• s : :ss s■■: : :� :1:1: 11 =_1;i ::1 l..yl s,
•■ , for wrecking, complete only Part J, for all others skip to IV.
: : :: :::14:::...t..............- .•■r•• :• ■■ : :'41 "_ ■• ;
::: :s :sass E. PRINCIPAL TYPE OF FRAME G. TYPE OF SEWAGE DISPOSAL J. DIMENSIONS
s :s : :a :.....::......... a ....... : a::....::
•■• ■. : 48. Number of stories
1111:1100::.::::::::!!:1::::::: •r■• 1 : :a: 30 1 !Masonr (wall bearing) 40 1 1 Public cr private company
i a: ••:a'::::: i! i : : • : N = ' •• ' = : •r = '::• • r : 49. Total square feet of floor area,
i i. •••• •: . : : :::.:. :s. _ : s .a s•mels as:: : _•_••••: s 31 M Wood frame 41 1A Private (septic tank, etc.)
all floors, based on exterior
a . ' :!: ::::::: s r•:1 a :. .. a ••r . r ■.! ::::::::;
�i iii : : : : :• : :•. :■!:: a : : : :i:a :s:a:: :x • a• • : r•■ :■ : : er w ee •N• . r , 32 1 1 Structural steel dimensions
..'�s : :s :l :.l :... : lN• =. :�: sH + :sx•N! :. rr ::l..! l :rr ■r■s■■seemse ■meeeee '
:: a::' l •N'i : 1 � • : : :: : : : : : : :' :' •■ • • :•:::: • :•••!• • :: : ••• t:: • 33 1 Reinforced concrete H. TYPE OF WATER SUPPLY
a$ : : :: d eS 1 : :Z■ ! t1a:•= ! ! : l :: ::::: N• •: l : : : : : : N• ■■Nr 50. Total land area, sq. ft.
• N■ • • • ::e •' iNN issee :•:66:::: � • • • • x •• : :::::: .a x ■ • xr■ 34 Othe Specify private pant
�: ::: sss : : : :slassll.:s� : : : :. : : : :.... ' r� : = : ::t� sl :N :! i: : : : :a:•: :': ::: : = I 1 – P f Y 42 Public or rivate cam
' �_ _:::' _ : y S : : :: •`!:: : : :l� :: • _ _•■:!!a•laa::::: �• :a :'•!!'_••:: :: 43 1 Private (well, cistern) K. NUMBER OF OFF- STREET
• • N •• • o N•rr .N 1 ■• N■ ■• ■ ■• • •■ N■ ■ 0
�;�s :� :g : : $ : : :s :s= ill!••:' ■•• "!'! :' : "'�3lrriui•lel : :::•■: laslss.s :N :• : : : ::. :' ! !.:• PARKING SPACES
ti • • • N x • • • • • • • • ■ • N■ N NU UN • • • ■ :aN■
as:: � :! . ■.. :=• li:ll�lslll : :•!■ : :•$gg s• • 51. Enclosed
1 :: :: � :as � i l •• s lli : •• :1 s•• : : : : : : r ::5 : :: :: : :::•s'•••: F. PRINCIPAL TYPE OF HEATING FUEL I. TYPE OF MECHANICAL
tt rr ••• • rr•r ■■ • .•. rr■N r rrr■ saw
111
t t f �i :: ■ :E :� s la =m��:
• a r :ilg! �,■ ads. a ■■ =!'a =!"'! : 35 l I Gas Will there be air 52. Outdoo
,, } i 11111110101111151 r � ae' = • r :• =r,:�!��_ ' aa =ice':$a; ? ;$ s a :aa:aaii•■: :rr r N.`I OE'lectricity 44 dirio 45 k L. RESIDEN BUILDINGS ONLY
iI> t r l : it {f No
.r s • ' L —� a 53. Number of bedrooms
j 111111111 r s{ z ' €�sa : :mi : :n g 1:1 , :..... s:.:s : 38 I1 Coal
. t , _ ' 1$ ,... .. :K :: I II 11111 i - ..1 .I ;. �t AIM_ r i=: I li ;��• lNa :: ii :aa: :a:: : :$1•�ig•�i�i: m:: ■':iN■N•• : : : : :: Z' 39 Other – Specify r; Will there be an elevators 1 Full 7. ; �� 54. Number of
46 1 1 Yes 47 I \ I N bathrooms
Partial
P`