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(1)
IV. IDENTIFICATION — To be completed by all applicants
Name Mailing address - A'umber, street, crtN, and Statr> ZIP code Tel. No.
l. y
Owner or �' f•���� S lrii A.��{i/)�N/�iI � '� J-A � % �C �71=X -Y- �� / C.sS
Lessee
Builder's
2. S f-`/V,IC_ 4 -te.((.Ilie € - —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 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 By Notes
Fee Started Approved
BUILDING
PLUMBING
MECHANICAL
ELECTRICAL
OTHER $ T
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
Permit
Permit 3
number
Building
Permit issued 72 19
Building f �-C/
Permit Fee $ !
Certificate of Occupancy S
Ap• by: 1Drain Tile
Plan Review Fee S—
TITLE
eft.
t" "A Q:,u1 of Northampton
. ,, �(�4' TlassricIITTSetfs
6T - 'Afire of tilt 31nsptrtor of {Suilbings APPLICATION FOR
ZONING PERMIT AND
Page //A Plot )r) BUILDING PERMIT
z
IMPORTANT - Applicant to complete all items in sections: I, II, Ill, IV, and IX. O
E.
_ ZONING
I. AT (LOCATION)
3 !.=A 5 c %. /Ai 7 %-.E % DISTRICT i to
LOCATION �P Y-(NO•) (STREET)
OF BETWEEN I` I of AND (CROSS STREET)
BUI LDING (CROSS STREET)
LOT
SUBDIVISION, LOT BLOCK SIZE
Cl)
II. TYPE AND COST OF BUILDING - All applicants complete Parts A - D m
A. TYPE OF IMPROVEMENT D. PROPOSED USE — For"Wrecking" most recent use m
—I
1 i I New building Residential Nonresidential
2 I I Addition(If residential, enter number 1252 One family 18 Amusement, recreational
of new housing units added, if any,
in Part D, 13) 13 I I Two or more family — Enter 19 Church, other religious
number of units— — — — --f 20 Industrial
3 I I Alteration (See 2 above) 14 I Transient hotel, motel,
21 Parking garage
4 V 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 Garage 23 Hospital, institutional
Part D, 13) 16 I Carport 24 Office, bank, professional
6 1 I Moving (relocation) Public utility
17� I Other — Specify
7 I I Foundation only 26 School, library, other educational
B. OWNERSHIP 27 Stores, mercantile
28 Tanks, towers
8 Z Private (individual, corporation,
nonprofit institution, etc.) 29 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
10. Cost of improvement $ 2-6-,0 school, secondary school, college, parochial school, parking garage for
/ department store, rental office building, office building at industrial plant.
To be installed but not included -,/` If use of existing buildin • being changed, enter proposed use.
in the above cost 4 Z
a. Electrical 4t „ iceit • ( 664}9‘'
b. Plumbing
t0 ii yc.
� I w
c. Heating, air conditioning
d. Other(elevator, etc.) 4. /'
0 11. TOTAL COST OF IMPROVEMENT !3 '2 C? (} _
III. SELECTED CHARACTERISTICS OF\BUIL. V DIN71 For new buildings and additions, complete Parts E - L;
for wrecking, complete only Part J, for all others skip to IV. D
O
E. PRINCIPAL TYPE OF FRAME G. TYPE OF SEWAGE DISPOSAL J. DIMENSIONS r71 m
48. Number of stories X
30 L J Masonry (wall bearing) 40 Ls Public or private company
49. Total square feet of floor area,
31 1-Csk Wood frame 41 I I Private (septic tank, etc.) all floors, based on exterior
32I I Structural steel dimensions
33 I I Reinforced concrete H. TYPE OF WATER SUPPLY
50. Total land area, sq. ft.
34 I I Other — Specify 42 N Public or private company
43 I I Private (well, cistern) K. NUMBER OF OFF-STREET
PARKING SPACES
51. Enclosed r-
F. PRINCIPAL TYPE OF HEATING FUEL I. TYPE OF MECHANICAL 0
35' I Gos Will there be central air 52. Outdoors
36 I I Oil conditioning? L. RESIDENTIAL BUILDINGS ONLY
37 I I Electricity 44 I I Yes 45 I I No 53. Number of bedrooms .�
38 I I Coal
39 I I Other — Specify Will there be an elevator? 1 Full 2
54. Number of
46 I I Yes 47 I I No bathrooms Partial