32C-161 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
Name Mailing address — Number, street, city, and State ZIP code Tel. No.
Owner or
Lessee
Builder's
2. 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
00 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
Date Date
Permit or Approval Check Obttai ed 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 ^ �j FOR DEPARTMENT USE ONLY
Permit number I
Building- Use Group
Permit issued C 19 3
Building ` r) Fire Grading
Permit Fee $ t' _
Live Loading
Certificate of Occupancy $ Occupancy Load
Zd by:
Drain Tile $
Plan Review Fee $
TITLE
CITY OF NORTHAMPTON
$� MASSACHUSETTS
r r
OFFICE of the INSPECTOR of BUILDI GS
,Vt Page y Plot APPLICATION FOR
ZONING PERMIT AND
INSPECTOR BUILDING PERMIT
IMPORTANT/ - Applicant to complete a// items in sections: I, I1, 111, IV, and IX. O
I ,) 1� / ZONING
AT (LOCATION) I" DISTRIC ^n
LOCATION (NO.) (STREET)
OF BETWEEN AND
BUILDING (CROSS STREET) (CROSS STREET)
LOT
SUBDIVISION LOT BLOCK SIZE
N
II. TYPE AND COST OF BUILDING - A11 applicants complete Parts A - D -�
A. TYPE OF IMPROVEMENT D. PROPOSED USE — For"Wrecking" most recent use M
M
1 ❑ New building Residential Nonresidential
2 Addition(If residential, enter number
/ 12 One family 18 ❑ Amusement, recreational
of new housing units added, if any,
in Part D, 13)
13 Two or more family — Enter 19 Church, other religious
number of units— — — — � 20 ❑ Industrial
3 Alteration (See 2 above) 14 ❑ Transient hotel, motel,
21 ❑ Parking garage
4 Repair, replacement or dormitory — Enter number
5 ❑ Wrecking (1/multifamily residential, of units ——————— — -- 22 ❑ Service station, repair garage
enter number of units in building in 15 ❑ Garage 23 ❑ Hospital, institutional
Part D, 13) 16 ❑ Carport 24 E] Office, bank, professional
❑
6 ❑ Moving (relocation) 17 Other — Specify 25 ❑ Public utility
7 ❑ Foundation only
f� 26 0 School, library, other educational
B. OWNERSHIP u / 27 ❑ Stores, mercantile
❑8 28 Tanks, towers Private (individual, corporation, � �
nonprofit institution, etc.) 4� f 29 ❑ Other — Specify
9 ❑ Public (Federal, State, or
local government) at+��
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,,,,,,, ,,,,,,, 1;W_tt1 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.....................
b. Plumbing .......................
c. Heating, air conditioning.........
d. Other (elevator, etc.).............
11. TOTAL COST OF IMPROVEMENT Is W-C)
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❑ Masonry (wall bearing) 40 Public or private company 48• Number of stories............... l
31 Wood frame 41 Private (septic tank, etc.) 49• Total square feet of floor area,
all floors, based on exterior
32 Structural steel dimensions .....................
33 ❑ Reinforced concrete H. TYPE OF WATER SUPPLY
34 ❑ Other — Specify 42 Public or private company
50. Total land area, sq. ft. ...........
43 Private (well, cistern) K. NUMBER OF OFF-STREET
PARKING SPACES
F. PRINCIPAL TYPE OF HEATING FUEL I. TYP OF MECHANIC 51. Enclosed ......................
35 Gas Will ther be centra it 52. Outdoors........................
36 oil conditioning.
L. RESIDENTIAL BUILDINGS ONLY
37 C� Electricity 44 ❑ Yes No 53. Number of bedrooms..............
38 ❑ Coal
39 ❑ Other — Specify Will It e be an elevator? Full..........
54. Number of
46 Yes 47 ❑ No bathrooms
Partial.......
erp a r t.'.cr, Bu lc'-,&,;,ft.ns ec Lior.:7
121 1�lain Strlrct z
BUILDING
PERMIT
VALIDATION
(F?
DATE DATE Jul-', 19, 19 PERMIT NO. 1V
APPLICANT "ary Jc,- cl.n
.c S .1-,ra .'icz ADDRESS 1()5. Bay RoaC. Ha k:1 cy
(NO.) (STREET) (CONTR'S LICENSE)
NUMBER OF
PERMIT TO ij Leration STORY 2 or :-C Ct Fa-il-Y DWELLING UNITS
(TYPE OF IMPROVEMENT) NO. (PROPOSED USE)
ZONING CB
AT (LOCATION) King-sley Avenue DISTRICT
(NO.) (STREET)
BETWEEN AND
(CROSS STREET) (GROSS 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
(TYPE)
t rc---.ovc _ a jj( _
REMARKS. r: to jj T)Vrcl-, arc' rc,-1)u 4.*1 on uin thc ssa�.,le location
PERMIT r)-
VOLUME
AREA OR ESTIMATED COST $ FEE
(CUBIC/SQUARE FEET)
OWNER a-fi J'are S'cinkc-"Lcz BUILDI aG
ADDRESS jr7 R�qy RL)pt�' < BY
WHITE - FILE COPY GREEN - FIELD COPY • CANARY - APPLICANT COPY • PINK - ASSESSORS COPY