29-343 (6) ZONING •
DISTRICT sweal4ft
REAR YARD
we M
jIX. SITE OR PLOT
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NOTES and Data - {For department use)
rb
IV. IDENTIFICATION — To be completed by all applicants
{/) Nome,( Mailing address — Number, street, city, and .Sfale �gZIP code Tel. No,
owner or
Lessee
2 Builder's
N License No. �6 J
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 B Date Plans
Fee Started y Approved BY Notes
BUILDING $
PLUMBING $
MECHANICAL $
ELECTRICAL $
OTHER $
VI. ADDITIONAL PERMITS REQUIRED OR OTHER JURISDICTION APPROVALS
Permit or Approval Check Date Number B Permit or Approval Chec Obtained ed Number By
Obtained y PP
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 '
II. VALIDATION
Building J.f
Permit number FOR DEPARTMENT USE ONLY
` 7�
Building_
r
Permit issued Use Group� �f lq `
Building y� 1 Fire Grading
Permit Fee $ � '�
Live Loading
Certificate of Occupancy $ Occupancy Load
pro ed y:
Drain Tile $
Plan Review Fee $
TITLE
CITY OF NORTHAMPTON
9• .� 4i- 40 MASSACHUSETTS
$ OFFICE of the INSPECTOR of BUILDINGS
t Page -" Plot `x APPLICATION FOR
ZONING PERMIT AND
INSPECTOR BUILDING PERMIT
z
IMPORTANT — Applicant to complete all items in sections: 1, 11, 111, IV, and IX. 0
(• AT (LOCATION) �'� � / ? ZONING '` rs
�j� � 'C �`� DISTRICT °��"
LOCATION INO.) r (STREET)
OF BETWEEN �U"�,e 0, E' AND �/0t care faj f.X,
BUILDING (CROSS STREET) (CROSS STREET)
LOT
SUBDIVISION LOT_T BLOCK SIZE
Vr
11. TYPE AND COST OF BUILDING — All applicants complete Parts A — D
A. TYPE OF IMPROVEMENT D. PROPOSED USE — For"Wrecking" most recent use m
—1
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 (If multifamily residential,
of units ——————— — -i 22 ❑ Service station, repair garage
enter number of units in building in 15 ® Garage 23 ❑ Hospital, institutional
Part D, 13) 16 Carport
240 Office, bank, professional
❑
6 ❑ Moving (relocation) 25❑ Public utility
17❑ Other — Speci/y
7 ❑ Foundation only 26❑ School, library, other educational
B. OWNERSHIP 27❑ Stores, mercantile
28 ❑ Tanks, towers
8 Private (individual, corporation,
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
-
L ? school, secondary school, college, parochial school, parking garage for,
10. Cost of improvement................
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 $
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
48. Number of stories...............
30❑ Masonry (wall bearing) 40 ❑ Public or private company
41 ❑ Private (septic tank, etc.) 49. Total square feet of floor area,
31 Wood frame p all floors, based on exterior
32 ❑ Structural steel dimensions ..................... ��' ,
33 ❑ Reinforced concrete H. TYPE OF WATER SUPPLY
p company 34 Other — Specify com an private 42: Public or 50. Total land area, sq. ft. ...........
❑ ❑
43 ❑ Private (well, cistern) K. NUMBER OF OFF-STREET
PARKING SPACES
51. Enclosed .......................
F. PRINCIPAL TYPE OF HEATING FUEL I. TYPE OF MECHANICAL
35 ❑ Gas Will there be central air 52. Outdoors........................
36 ❑ Oil conditioning? L. RESIDENTIAL BUILDINGS ONLY
37 ❑ Electricity 44 ❑ Yes 45 No 53. Number of bedrooms..............
38 ❑ Coal
39 ❑ Other — Specify Will there be an elevator" 54. Number of Full..........
bathrooms
46 ❑ Yes 47 No Partial........
DEW UILDING INSPECTIONS
BUILDING ZO
! 212 Main Street I a r �°�
"� Northampton, MA 01060 PERMIT l..-'�
3 43 f VALIDATION
,�` i G) aD aTE �4' �� t9 i� EFtM T
r--
APPLICANT ADDRESS
IN0.1 (STREET) ICONTR'S LICENSE)
NUMBER OF �r
PERMIT TO (_1 STORY DWELLING UNITS
(TYPE OF IMPROVEMENT) NO. (PROPO USE)
3 ZONIN /
AT (LOCATION) / �+ DISTR if
(NO.) ISTREET)
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
(TYPE)
REMARKS;
VOLUME ESTIMATED COST $ �� 0 Rte• PERMIT
e. /30 DARE FEET)
OWNER
y BUILD!
ADDRESS BY
WHITE - FILE COPY . GREEN - FIELD COPY • CANARY - APPLICANT COPY • PINK - ASSESSORS COPY p'jNop