11A-005 IV. IDENTIFICATION — To be completed by all applicants
Name Mailing address — . \'rrmbc°r, strcr't, fit >, anI Statc . ZIP code Tel. No.
' ae4 , . A;.• ` I z� � NOTES and Data — (For department use)
Gwner or - L� e�'
Lessee
2 aL,�W�' so-- nA' Builder's
License No.
Contractor
3.
Architect or
Engineer
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
g
DO NOT WRITE BELOW THIS LINE
V. PLAN REVIEW RECORD — For office use
Plans Review Required Check Plan Review Date Plans By
Date Plans B Notes
q Fee Started y Approved y
BUILDING
—
PLUMBING $
MECHANICAL $
ELECTRICAL
OTHER
VI. ADDITIONAL PERMITS REQUIRED OR OTHER JURISDICTION APPROVALS
Date Date
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
44'0 FOR DEPARTMENT USE ONLY
Permit number
Building. q� Use Group
Permit issued d' / 19
Building C J Fire Grading
Permit Fee $ ` O ' 0 0
Live Loading
Certificate of Occupancy $ Occupancy Load
Appr y:
Drain Tile $ r
Xt ___
Plan Review Fee $
TITLE
4-
• ,Z P • ` CITY OF NORTHAMPTON
9w ` . )f,, :,;,` MASSACHUSETTS
VIII. ZONING PLAN EXAMINERS NOTES `�' _ ,
$ wig: OFFICE of the INSPECTOR of BUILDINGS
VI DISTRICT ,+ ii � �
Page �! /� 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. , /n 0
SIDE YARD SIDE YARD /_ r c.+r ZONING t{ f2,4
I. AT (LOCATION) c(v DISTRICT
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
X
A. TYPE OF IMPROVEMENT D. PROPOSED USE - For' Wrecking" most recen u m
m
-4
1 I I New building Residential Nonresidential
Wil ere be an elevator', . �
2 I Addition ( residential, enter number 12 One fami I Amuseme, recreational
of new h ousing units added, zf any,
IX. SITE OR PLOT PLAN — For A l ieant Use in Part D , 13) 13 T fily - Enter
19 18 I Church, oth religious
.�.. PP number of more units am- e
- - t r
.64; ar�irrate" Nr•i as• • ••r.NNN ■s..s •� - 20 �� Industrial
N.•••r•rr r 3 I Altera (See 2 ab ove)
•ari• r • .: •iIw "NS•Nr w•
14 I Transient hotel, motel, 21 Li Parking garage
ar■ N.w NraraNNrma.ueuN •N:•amN ■.e..assaar:::.• 4 I I Repair, replacement or dormitory - Enter number
! • •rr•r•a• ••N ■ r•••aa U
}r - U r rtr•NpNrr r!N• a a
: -yi °°° .■r N•■1 � ■ •r" . " r•■ws••�•r i•sra■■ r aa r• • #■ rNS r 22 Service station, repair garage
•
••• ■■ • " 7 ii"°'ar r 5 I W re ;;Di ng (I( multifamily residential of units - --� P 9 9
•r • :: rue• r ■ ■ s a : • • • a NN�ura
1121.11". ■ r.•r R ^ " .a �r��i i�l" rw i i� r "rN "Nr•a ■' • ■■w ...esi : ■r. en number o units in buildin in 23 Hospital, institutional
"" rulw • . srs a• r■ * J g 15 �� Gara I 1 P
_■ N r
• a ar•• rraa• Y• •• • ■ •wr•N•N• r Par, 13)
"r '3 • ■ s�iiii I � NN N�r■ �w Nr ' N�• • rr ■rN■ 16 I 1 Carport Li i, k a ww. nwr•: ■ aN N ■r •r wNNN••.■rs • ■sw• r■ ■ 6 I I Moving (relocation) 25 24 Pu ce uti
a� ■ ■ aN ■ rr ■ra.SRN a.US..rr
arp Ciii iNi"i w ui ' i ■ wors i ono t� •I ........... ............. u... 17 Other - Specify Y , professional
aw■ s. ■ rw aNNr■a 7 Foundation only
an r••r:wNr :w:::41 .:: 1•: :h :. :E 1 = rat:ir■w #■lii■bi w.r••p...a.a..." r I 1 26 1 School, library, other educational
:i "" + • ■NN ■■■ #�aaw'i'Nrni�iia...iN . r. ��C6-4- ACRJ - 27 I Stores, mercantile ii L :I'wsrr•r0i. ■ ■a ■ B . OWNERSHIP
rw • •r rr r ee e i 28 Tanks, towers
i rs ":.r ..•■■•. :: :I l :: wa r. • ' 1 ( p �'. - k $ —t r I J IP 8 Pnvate individual, car oration,
i r w . .• • : rr • • . :: .s : o r• ma r nonprofit institution, etc.) 29 I I Other - Speci /
■ II1 ■ a • NwN mass •ua.N.• •
N • rp •a •
":::*--**11:1!" • aN ■r: a r• 9 I I local ca ( emmal, State, or
r
:
ra a ■ Zwaiaa • •■ •� C. COST (Omi cents)
a :• a Na a■ s ::: r Nonresidential - Describe in detail proposed u of buildings, e.g., food
■ •
Nwr •r
� ir• a �i • : NN : :N I meow //. processing plant, machine shop, laundry building at hospital, elementary
" -
10 Cost improvement $
'� NrN •rr•i . of [ ✓O school, secondary s chool, college, parochial school, parki garage for,
•
;iiiiiiiiiiilL 40 Ili ****I filiiiiiii :12 1 ;4 " ; : N .• : • �� • IN ..:•a.N:NS•rNN P g, office buildin p
N ■ •Ir - de artment sto rental office buildin gat i ndustrial lent.
• ••N • N • N Nwr N•N . To be installed but not included If use of existing building
is being changed, enter proposed use.
a � M a O :I ■•r• • � N N•Nr r
. Nr ■ ■� ma. • in the above cost
N : :an al r Nara r : ■r■ ■ i ■ •� I � i �E � aria loos •• a. Electrical
i•'iN 6 ■ r :a r .. u......i ' a • 1 •
r "1"6"::::: � rNr me
MLA am y & .• rs e .e..... : •N•r• ..... ■ . r : a = a s ■r I NNN.• •. b. Plumbing
• •• Na■ iN II N•
" �• •ar ..m:...aaa..u.IIa�. N •a unn I lN _ c. Heating, air conditioning
1 1 :7 n`rorniegr nvmemossu r • N :: ra:• • N..•.e..w■N. ■
r as .ii i trim .u. ems rm..■N■na.NN: �_ • ■_ :i d. Other (elevator, etc.)
• ii i 11. TOTAL COST OF IMPROVEMENT $ L
" • :r :a ■CIIII ::::::=1,...::::::14 ii _ ■ :
' i i ' _ a7:� • : ' � " " '•:5" :: III. SELECTED CHARACTERISTICS OF BUILDING — For new buildings and additions, complete Parts E — L;
• ■ w i N•NfN ■M ■r •N ■ •• rraar� •• ■ r
N Nws ■r•..aaN ` �N N■N : ■ : for wrecking, com plete only Part J, for all others skip to IV.
■i � ::::�::: >f : : •...� : aN i NNN I :: err • • .• ■ ■:■
w 1 u • ,+j a. . :::::!!:::::::::::::as .................................................
■ s ::
•a r ■ : I :::: =:Il lt:i s•$ I'i ims. re E. PRINCIPAL TYPE OF FRAME G. TYPE OF SEWAGE DISPOSAL J. DIMENSIONS
1 • Ira r ■rN Si iri ... . a NrrNi . 48. Number of stories
::11 111 ; ;; ; ;;;111111 el
. ..: : ::: a l w•a I ■ swum: a. i.I ■ r 30 I Masonry (wall bearing) 40 ® Public or private compan f ll2� S•S I a � ��I a .s •w ■ ■N•■ ■ =:_• w•■ 49. Total s quare feet of floor area,
• iiiiifi3 ii S 11:I: .� » • � 31 Wood frame 41 I I Private (septic tank, etc.)
fi //!y•�. all floors, based on exterior
r H •••7a N Nrr wna•� • �•Nata■:■
u:a1:wr■ N ■CI ■ • • : r ■■•I r 32 I ucura H. TYPE OF WATER SUPPLY
41 2 4221/62:11 :1-1i1111:140111911411111:8:1111.1
dimensions
.� _ .
oll
� . II _. s : :aw'ila :I y " aauS w.. ■ N w
a � Nr•wNa ■� is :ili4 i ■:ar.•e• .r••N• : ■r•a : :r:I:
■: t 1111111111115111141:" N r s .e.: 33 1 Str Rein d st c o cr ete
I r ■ a : 50. Total land area, sq. ft.
nla 34 Other - Specify 42 Public or pnvate com pan y _
• • a • • a• N • ■ s Na
'' • : : • ■ 43 I I Private (well, cistern) K. NUMBER OF OFF- STREET -ma 111: $ + ? _w :i 'r:rN•NNr•NN■ PARKING SPACE S FIE +r r ; _ i�: .aa • ' I�i.:
1 ? m ::::::::::::::::*MOOS: •� ■ a waww 51. Enclosed
' F. PRINCIPAL TYPE OF HEATING FUEL I. TY' OF MECHANICAL
. : r•
• ::•Na•N
• NN•
Y = t , + t a • • :: :� i � � ■ � I � � i ! �I,■:I II �� a r•
: 41 1- . + :�s•rr du Ni• ■■a • : 35 I Gas Will the be centra • a 52. Outdoors
Ill } $? t ii-li t r r w■ r : � :: : � �' 36 II oil conditioning: L. RESIDENT BUILDINGS ONLY
A im � r � i ��
i < a }� � ` ■ ' ■ Z il� •S i : r a�:: I ::: : :I :: :SNNwr• 37 L - Electricity 44 1 1 Yes No 53. Number of be
1 � } �t }� N :':
� : ■�� =
- `f * " :� - Itri �+NI:� ng rsS 3B! ■••8 ::•■N•: : u : 38 I Coal
39 I Other - Sp /y Full
54. Number of
46 L i Yes 47 I I No bathrooms
Partial
BOCA FORM APEBP - 669 C1969 BUILDING OFFICIALS & CODE ADMINISTRATORS INTERNATIONAL, INC. -