32C-140 (8) 1
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FRONT DISTRICT
SIDE YARD SIDE YARD
REAR YARD
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NOTES and Data — (For department use)
1
IV. IDENTIFICATION — To be completed by all applicants
Name Mailing address — Number, street, city, and State ZIP code Tel. No.
Lessee lb 1+ 64 pO 7
2• 1 ( License No. 41'3
Contractor
002��
3.
Architect or 410 6p `�'I
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.
0 of app icant C/ ` Address vdY �I '1 f �vApplication date
EZU—r
',,/,, � ? U• t30y ( O (o A 441 f r f 5 f 10 2
o5
00 NOT WRITE BELOW THIS LINE
V. PLAN REVIEW RECORD — For office use
Plan Review Date Plans Date Plans
Plans Review Required Check Fee Started By Approved By Notes
BUILDING $
PLUMBING $
MECHANICAL $
ELECTRICAL $
OTHER $
VI. ADDITIONAL PERMITS REQUIRED OR OTHER JURISDICTION APPROVALS
Permit or Approval Check obttaineed 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
I1. VALIDATION
Building IQt' FOR DEPARTMENT USE ONLY
Permit number
Building. � use Group
Permit issued 19
Building Fire Grading
Permit Fee Live Loading
Certificate of Occupancy $ occupancy Load
Approv
Drain Tile $
Plan Review Fee $
TITLE
CITY OF NORTHAMPTON
MASSACHUSETTS •
R OFFICE of the INSPECTOR of BUILDINGS
w r Page Plot �y� APPLICATION FOR
NSPECTOR ZONING PERMIT AND
BUILDING PERMIT
IMPORTANT — Applicant to complete all items in sections: 1, 11, III, IV, and IX. O
a /� _1y ZONING )
AT (LOCATION) / ' fk/ f G4yee 1 DISTRICT.
OCATION ("O•) (STREET)
F BETWEEN ��UV1( _ �1"e AND M►G�tD1�° t t'�1J�'
UILDING (CROSS STREET) (CROSS STREET)
LOT
SUBDIVISION LOT BLOCK SIZE
N
TYPE AND COST OF BUILDING — All applicants complete Parts A — D
70
k. TYPE OF IMPROVEMENT D. PROPOSED USE - For"Wrecking" most recent use ttn
M
-�
1 New building Residential Nonresidential
20 Addition(I/ residential, enter number 12 F_� Pne family 18 0 Amusement, recreational
o/ new housing units added, if any,
in Part D, 13) 13 FeTwo or more family - Enter v 19 EJ Church, other religious
number o/ units- - - - * 200 Industrial
3 � Alteration (See 2 above) 14 E Transient hotel, motel,
21 D Parking garage
4 Repair, replacement or dormitory - Enter number
5 ❑ Wrecking (1(multi family residential, of units ------- - -.. 22 ❑ Service station, repair garage
enter number of units in building in 15 7i Garage 23 ospital, institutional
Part D, 13) 16 0 Carport 24��ice gq,,_profe�pn
6E] Moving (relocation) —6 t
17F-1 Other - Specify 25 ublic utility
7 Foundation only 26 School, library, other educational
B. OWN HIP 27�Sro wrperr intile
8 Private (individual, corporation, 28❑ To�y�Kls, tTTow-Tir}�s
nonprofit institution, etc.) 29 Other - Specify
9 ❑ 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,,,,,,,,,,,,,,,, S chool, secondary school, college, parochial school, parking garage for,
deportment store, rental office building, office building of industrial plant.
To be installed but not included If use of existing building is being changed,enter proposed use.
in the above cost t+�
a. Electrical..................... 1
b. Plumbing .................... ll
c.Heating, air conditioning.......
d. Other(elevator, ete.)............ NA".. VN1L1'T 1 � �
11. TOTAL COST OF IMPROVEMENT f (Jf?W AwQ J,OtvS
III. SELECTED CHARACTERISTICS OF BUIL 1NG — 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 SEWAGE DISPOSAL J. DIMENSIONS
30 osonry (watt bearing) 40 Public or private company �• Number of stories...............
31 Wood home 41 Private (septic tank, etc.) Total square feet of floor area,
all floors, based on exterior 1 ,�(�./�
32� Structural steel dimensions .................... a'3 d {;/
33 Reinforced concrete H. TYPE Pf WATER SUPPLY
�
Lr�J
34� Other - Specify 42 Public or private company 50. Total land area, sq. ft. ...........
43 F_� Private(well, cistern) K. NUMBER OF OFF-STREET
PARKING SPACES
F. PRINCIPAL TYPE OF HEATING FUEL 1. TYPE OF MECHANICAL 51. Enclosed ....................... a
35 Gas Will there be central air 52. Outdoors........................ a
36 ❑ Oil conditio "ng?
_ L. RESIDENTIAL BUILDINGS ONLY /��
37 E_l Electricity 44 Yes 45 F7 No 53. Number of bedrooms.............. 't" f -'
38 Cool
39l__� Other - Specify Will there be an elevotoO Full..........
54. Number of
46 � Yes 47' No bathrooms partial........ t�
DEPT. OF BUILDING INSMCTIONS^ BUILDING z=
! 212 Main Street
Northampton, MA 01060 PERMIT
3 Kt rr V VALIDATION
« GATE 19 PERMIT
_Vi2L�
APPLICAN ADDRESS
two.) (STREET) (CONTR'S LICENSE)
(`) ��� � � NUMBER OF
PERMIT TO STORY DWELLING UNITS
(TYPE OF IMPROVEMENT) N0. — # (PROPOSED USE)
ZONING «
AT (LOCATION) �� DISTRICT
(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 F,"NDATION
Al—
REMARKS: (TYPE)
J
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AREA OR .,Q./ �'�' v ESTIMATED COST L =✓a Gl Q `� — FEEMIT
VOLUME
(CUBIC SQUARE FEET) 3
OWNER BUILDIN P
BY
ADDRESS ,
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