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VIII. ZONING PLAN EXAMINERS NOTES
DISTRICT
USE
FRONT YARD
SIDE YARD SIDE YARD
REAR YARD
NOTES
IX. SITE OR PLOT PLAN — For Applicant Use
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NOTES and Data — (For department use)
IV. IDENTIFICATION — To be completed by all applicants
1. CN`aame r,�'A Q� iMaiiling��a�dydre's�sA— Number, street, City, a .. fate ZIP code �yT'el.l. No.
Q/'
Owner or Md5e�h M�I�oY),1 /CJ h+ I C� �vY( �e / l�� 5'd {" /O
Lessee
2. I�IN� e V �� /"/ e (C I 4°(°3p LBicuenldsee r'No. 005
76 54%
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 Ol0'S8 Application date W/A7
("oez/
/03 /11,/ 57L- 44-rel-e fd,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 $
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
--4
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
Building p,
Permit issued g / 19 D 7 Use Group
Building Fire Grading
Permit Fee $ 3,2(00 Live Loading
Certificate of Occupancy $ Occupancy Load
Approv by:
Drain Tile $
Plan Review Fee $
TITLE
` � CITY OF NORTHAMPTON
MASSACHUSETTS
r �(� 0 ICE of the INSPECTOR of BUILDINGS
.,_ • Page cAF Plot V4.1('' APPL I CATION FOR
INSPECTOR ZONING PERMIT AND
BUILDING PERMIT
z
IMPORTANT — Applicant to complete all items in sections: I, II, Ill, IV, and IX. 0
�S[ {..� /// _ � ZONING
) fcf P ZONING cie i ��
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 -1
A. TYPE OF IMPROVEMENT D. PROPOSED USE – For"Wrecking" most recent use m
M
1 I .1 New building Reside tial Nonresidential
2 I I Addition(1/ residential, enter number 12 rvr One family 18 I Amusement, recreational �{
of new housing units added, if any, ' '1
in Part D, 13) 13 I I Two or more family – Enter 19 LA Church, other religious
number of unit's– – – – –> 20 LA Industrial
3 I i I Alteration (See 2 above)
14 I I Transient hotel, motel, 21 L-1 Parking garage
4 I I Repair, replacement or dormitory – Enter number
5 I Wrecking (If multifamily residential, of units – i
22 El Service station, repair garage
enter number of units in building in 15 I I Garage 23 LA Hospital, institutional
Part D, 13)
1.0..
16 I I
Carport
24 Office, bank, professional
6 I Moving (relocation) 17 _�Other – S p eci fy-4 4 0" '�j
25 Public utility
7I Foundation only
` 26 I I School, library, other educational
B. OWNERSHIP .+ Zvi( ✓� Yo Uyy 27 I I Stores, mercantile
8 Private (individual, corporation, �J I _I/ 28 I I Tanks, towers
nonprofit institution,etc.) ��VQ� 'XIS if.(.Q c1.29 I I Other – Specify
9 [ I Public (Federal, State, or (� V
local government)
C. COST (Omit cents) Nonresidential – Describe in detail proposed use of buildings, e.g., food
��yy /l processing plant, machine shop, laundry building at hospital, elementary
10. Cost of improvement $ V �•f ) 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 building is being changed, enter proposed use.
in the above cost
a. Electrical e'OC
b. Plumbing X900/Oa
c. Heating, air conditioning l CO (00
d. Other(elevator, etc.)
11. TOTAL COST OF IMPROVEMENT $ 000a.oc
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 fl M onry (wall bearing) 40 Public or private company 48. 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 (91`'g'32 I I Structural steel dimensions
33 I I Reinforced concrete H. TYPE,F WATER SUPPLY
34 I I Other – Specify 42 riPublic or private company 50. Total land area, sq. ft.
43 I-1 Private (well, cistern) K. NUMBER OF OFF-STREET
PARKING SPACES
F. PRINCIPAL TYPE OF HEATING FUEL I. TYPE OF MECHANICAL 51. Enclosed
35 I I Gas Will there be central air 52. Outdoors
conditioning?
36 I cI L. RESIDENTIAL BUILDINGS ONLY
/
37 D Electricity 44 L ✓'N
_ i Yes 45 o 53. Number of bedrooms
38 I I Coal
39 I I Other – Specify Will there be an elevator? Full / /
54. Number of
46 I 1 Yes 47 No bathrooms Partial
111111F 'I'
•°1"
•Al*
lir
O U. DEPT. b g, 00
ortham P to PERMIT 060
vit8 VALIDATION
DATE M /8 / O0 f-7 4�
APPLICANT I„/ T
/�
(NO.) (STp ) (CONTR'S LICENSE)
//_ /�/,,,���,,i,,,,,,a����.- """ /�/J,14la NUMBER OF /
PERMIT TO OVE (_I STORY_L ✓ Lt i�/^q� �"° ((( DWELLING UNITS r
(TYPE OF IMPROVEMENT) NO. (PROPOS D USE) &iv+, '/ A
ZONING AT (LOCATION)
? V .� DIISTR CT °'� �•
(NO.) (STREET)
BETWEEN AND
(CROSS STREET) (CROSS STREET)
LOT
SUBDIVISION LOT BLOCK SIZE
BUILDING IS TO BE FT. WIDE BY FT. LONG BY FT. IN HEIGHT AND SHALL CONFORM IN CONSTRUCTION
TO TYPE USE GROUP BASEMENT WALLS OR FOUNDATION
'_ ,! /yam., LI ��r/�, '/,(�� ///� //�/ (TYPE)
REMARKS: ` �- %Z�1LI�C�' „10611, �-YJ �il�+`^-^L+ 1/J+`c�Y SF�'�
I
AREA OR P..8 6 4e; J'ESTIMATED COST $ ® 0 v '- ;arm- $ 3aeoc
VOLUME
POVIHIN4SOUARE FEET)
OWNER /----�4 , /�,�� .N• .. �, BUILDINft, �� � ,
. ,
ADDRESS BY ��-
WHITE - FILE COPY . GREEN - FIELD COPY • CANARY - APPLICANT COPY • PINK - A SESSORS COPY P'iNT ,P
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