17D-012 (10) •' . CITY OF NORTHAMPTON
if MASSACHUSETTS
1
J it Ai OFFICE of the INSPECTOR of BUILDINGS
1 1(l
�:r Page Plot f APPLICATION FOR
ZONING PERMIT AND
INSPECTOR BUILDING PERMIT
z
IMPORTANT — Applicant to complete all items in sections: I, II, III, IV, and IX. O A AJ I. // /� /�
//�,��/ f� y � ,� y am, ZONING �//J°\
AT (LOCATION) `�s�� ® V` -�-�✓• D ISTRICT _!�
LOCATION (NO.) (STREET)
OF BETWEEN AND
BUILDING (CROSS STREET) (CROSS STREET)
LOT
SUBDIVISION LOT BLOCK SIZE
N
II. TYPE AND COST OF BUILDING — All applicants complete Parts A — D -I
xl
A. TYPE OF IMPROVEMENT D. PROPOSED USE — For "Wrecking" most recent use m
m
-
1 I New building Residential Nonresidential
2 IX Addition (If residential, enter number 12I I One family 18 I Amusement, recreational
of new housing units added, if any,
in Part D, 13) 13 X1 Two or more family — Enter 19 Li Church, other religious
number of units— — — — --> 20 LA Industrial
3 I I Alteration (See 2 above) 14 ransient hotel, motel, I Transient l 21 I Parking garage
4 I I Repair, replacement or dormitory — Enter number
5 I I Wrecking (If multifamily residential, of units — .. . 22 Service station, repair garage
enter number of units in building in 15 I I Garage 23 I Hospital, institutional
Part D, 13)
16 I 1 Carport 24 Li Office, bank, professional
6 Moving (relocation)
17 I 1 Other — Specify 25 Public utility
7 I Foundation only
26 I School, library, other educational
B. OWNERSHIP Af4 241 27 I Stores, mercantile
8 54 Private (individual, corporation,
28 j Tanks, towers
nonprofit institution, etc.) 29 1 Other — Specify
9 I I Public (Federal, State, or
local government)
C. COST (Omit cents) Nonresidential — Describe in detail proposed use of buildings, e.g., food
processing plant, machine shop, laundry building at hospital, elementary
school, secondary school, college, parochial school, parking garage 10. Cost of improvement $ -ciao � Y 9 P P 9 a for, 9 9
department store, rental office building, office building at industrial plant.
To be installed but not included If use of existing building is being changed, enter proposed use.
in the above cost
a. Electrical
b. Plumbing
c. Heating, air conditioning
d. Other (elevator, etc.)
11. TOTAL COST OF IMPROVEMENT $ 4 7 1 000
III. SELECTED CHARACTERISTICS OF BUILDING — For new buildings and additions, complete Parts E — L;
for wrecking, complete only Part J, for all others skip to IV.
E. PRINCIPAL TYPE OF FRAME G. TYPE OF SEWAGE DISPOSAL J. DIMENSIONS
30 I Masonry (wall bearing) 40 kl Public or private company Number of stories
31 Wood frame 41 I I Private (septic tank, etc.) 49. Total square feet of floor area,
all floors, based on exterior
32 I I Structural steel dimensions
33 I Reinforced concrete H. TYPE OF WATER SUPPLY
34 I I Other — Specify 42 4 Public or private company _
50. Total land area, sq. ft.
43 I I Private (well, cistern) K. NUMBER OF OFF - STREET
PARKING SPACES
51. Enclosed
F. PRINCIPAL TYPE OF HEATING FUEL I. TYPE OF MECHANICAL
35 I I Gas ,. i there be central air 52. Outdoors
36 Oil conditi• 'ng?
L. RESIDENTIAL BUILDINGS ONLY
37 L_ I Electricity 44 Li Yes No 53. Number of bedrooms
38 Li Coal
39 I - I Other — Specify Will there. .e an elevator
Full
54. Number of
46 L, 47 I I No bathrooms
Partial
IV. IDENTIFICATION - To be completed by all applicants
Name a,I� ,.,Q�Mailing address — Number, stmt, city, and State ZIP c$ w Tel. No.
1.
Owner or
Lessee ..
," Builder's
2. '�C ' � .��'�c- s�y --4' License No.
Contractor /:. ! a:
)�������'�
3. ^n�`�
Architect or � r 9‘14,
Engineer p
I hereby certify 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,gnatur of applicant r-� Address t- Application date
f :' 2' zG, ,�� f -, 4 f. "1 e i/
DO NOT WRITE BELOW THIS LINE
V. PLAN REVIEW RECORD - For office use
Plans Review Re uired Check Plan Review Date Plans B Date Plans B Notes
9 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 FOR DEPARTMENT USE ONLY
Permit number 7/
Building- Use Group
Permit issued "221 - Al 19 _
Building /1 Fire Groding
/
Permit Fee $ l ., d� Live Loading
Certificate of Occupancy $ Occupancy Load
'•prove• by:
Drain Tile / 1 :2-aelC-V
Plan Review Fee $ t
TITLE
NOTES and Data - (For department use)
et g,-4-:e'tP4)—ee-+ , ,-- Ae_P
/
S`-0 / - f2
VIII. ZONING PLAN EXAMINERS NOTES
DISTRICT
USE
FRONT YARD
SIDE YARD SIDE YARD
REAR YARD
NOTES
IX. SITE OR PLOT PLAN —For Ap plican t Us e
• :r. S.
r■.lr•arar.. t j . •ul,r/aa,raal,. u, ■.u
i :uaurr: .a al i aa�'uiUrur. r.i aa""•'ra � i
. 1 :L." • •5••.aar.`■*a.r auaa : . a r a
•ur■ i* iL l r �_• a a ar■.u w u.....a'lllfaiau•u...u. a ■�rr rurN •
iii' i � N aaa.• i aa.,r
i aa*SS °ia:i %�ia:t�rl� _ lair aa�eu� ru:
I• ii ... r rrs•aa ia.ru' .... a.a...s as
1:::::::::11:23:::.::::* .ar l ur u u .■.+ "!. ■r ■ as u.. , a a , •
. ...a . .i . .ii• .... .. :a a .. iaauiii� ... : :!!!!rfrr.•...... as s i { t�� ......U. ia• ur■
'. . i ' a �u7 ":"4 S 5a::""'aai•aa asayabuailaaraaii u•a a yraarurtalu�:la
. a UU 5 . rr U rrri ur ■ .•r a r .. i• :it.
us a� R • a .S .la . is■ r. .....s a i ru. ■ hai r ■ua r • �ru�r■ ...
.a,a a i a■ . u. a
a.i.•.. as ■i a jj ;. '. tsar p • �q�. r
il ia : a ! .U..a u rir•�rar#IaM � .. llra•u•r.uarruuo■a ..
M S ..�.� yI.��.�.y � l a ■•■■ .S.ari" ..S...�... .r.r.......... •a .........
aa. ..aaiq' u � r u � t � r a4 • , i..pu ■ aaa.NH U .• pp ra � fr tart
a a : • a �11 . a..0 ......a Iq� I... r ' .a,aur � l
a l a l .
a...l lira . .s:. . /..q. .r_I�Harp�y i••�.••r•ral�al=rrr• ia�rar
is . : u: ..... a...�..�s........:: a... 1 ' • '
r� .s. a _ a iiiuuurau. r r
. rut ` a • •a .. . i si I , • •a..s . ■�r ssiai S .aa i a..l• .
a l .� • a a'"iaa adik i mps i , rrr : raa r :iaaaaaa•ra•
"em
� ...S.r ..uwr ...ma lum. .
asa i ���� �� ' .....aai... l.. .
.. .. �... . .G.. I dea our i•ai
r�iii a i •rr•u'iN..
l a. . ea " r aii$$ .eaa a.• a : * i ..
�i:a..s au t: a:aa..a..aa i ■ . : : i u,
a s a ai �isi iis slaw remain r.a r a :: sa : a:aa
'i! a .a • .�
..a.. a all#a.a arm .
a a . . uu a a i�
H �� t �a � .� a aa as :1a1 a :: Saauraau• N a
a a i : ■ a:a1 ■ I .
ila.S alaua.a..0 ..■ aa. :ra • a.ra. ' :
...r' a : i a a ras..s..., "anal iiasa::iia::saai
41811:111 aa ia... aa_ . aa : rus a......u.. aaaasa s.aua,i.anruuaa. ro a
Illg
r a .... •... ..: r a:ii aaaa s a . .a aiiuu r. • .. r
:::::::::::11°14 a 1'1 ::11• :.a.. ■s• 11ssssa ■M•:s: l..:assaa.as.s .
11111111/11%/1/1"4:1 r ar• a a s : .. ':
*WWII a • as ua
41 " . " : "::81/1:12:1:18:11:10a e. . ss : r s.au..: aaaa :::::::...U..uUa .a: r ss. s s ::sas a . ra a s • s,a s s.ra
1 111 111 111111111 11 1 1111=21 1 1 1 12 i ffi i t l ikt::::ii:!: .i.. uuaaa am I...aai u:u,auuaa•a :s : ,• a.au. U.. aa : ..a.a a .a..a. . ... � ....i...:saa•.aas.a•a _ :
• u ■ . ■ • .,i� r a.a.. ua.....s...ia . ..an :$�$$ $ � $ s� a a ta r r i• .a • a i:: aa, a 1. :$a ;1. a.aa.... . a : aa • s ': s ea 'ern
: ""116:6::
it 6r ru a . r
I
a .. . aria r us . u a
'' 11 1111 61 * ** 111 1111: *gasaanine ammangle o ,..raa Is iir l �U• • . ir"'f.riG isii aa i a i :aa : : r '
i a au: a aa ••:
■ aaii
} 2. is s s aa - i ' • a '" • tiara
111111:1- 1 1-14171 +' e �� a �� 111111:01:1016 h a s � � >:'. a .a a a : a:..6s1i,;Zi�
i
1- � � a .: r i .sasa l i typosi 1 maa :aa : aaraa ;�_••�iv..r : s
BOCA FORM APEBP - 669 C1969 BUILDING OFFICIALS & CODE ADMINISTRATORS INTERNATIONAL, INC.