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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 d � �� / -e
Lessee /
Builds
2. Sao o^,,r, e cok, ! / 7 L, 514 Licenser'N o. ooh/
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 da�te
00 NOT WRITE BELO THIS LINE
V. PLAN REVIEW RECORD — For office use
Plans Review Required Check Plan Review Date Plans B Date Plans B Notes
Fee Started y Approved y
BUILDING $
PLUMBING $
MECHANICAL $
ELECTRICAL $
OTHER $
VI. ADDITIONAL PERMITS REQUIRED OR OTHER JURISDICTION APPROVALS
Permit or Approval Check Date Number By Permit or Approval Check Date Number B
Obtained Obtained Y
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 FOR DEPARTMENT USE ONLY
Permit number
Building Use Group
Permit issued lq
Building Fire Grading
Permit Fee $
Live Loading
Certificate of Occupancy $ Occupancy Load
Approved by:
Drain Tile $
Plan Review Fee $
TITLE
...
CITY OF NORTHAMPTON
g. MASSACHUSETTS
$ OFFICE of the INSPECTOR of BUILDINGS
Page Plot APPLICATION FOR
ZONING PERMIT AND
INSPECTOR BUILDING PERMIT
z
IMPORTANT — Applicant to complete all items in sections: 1, 11, 111, IV, and IX. O
ZONING
I• AT (LOCATION) DISTRICT
LOCATION (NO') (STREE )
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 ;0
A. TYPE OF IMPROVEMENT D. PROPOSED USE — For"Wrecking" most recent use m
-4
1 ❑ New building Residential Nonresidential
2 ❑ Addition(If residential, enter number 12 01C One family 18 ❑ Amusement, recreational
of new housing units added, if any,
in Past D, 13) 13 Two or more family - Enter 19 ❑� Church, other religious
number of units- - - - 20 ❑J Industrial
3 ❑ Alteration (See 2 above) 14 Transient hotel, motel,
❑ 21 Parking garage
4 Repair, replacement or dormitory - Enter number
5 ❑J Wrecking (If 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 �� Office, bank, professional
❑
6 ❑ Moving (relocation) 25 ❑ Public utility
17 ❑ Other - Specify �t
7 ❑ Foundation only �A / 0 26 ❑ School, library, other educational
B. OWNERSHIP �OL0 IJ E'(� C.[ Y! "0 27 Stores, mercantile
28 Tanks, towers
8,� Private (individual, corporation, ❑
nonprofit institution, etc.)
29 E] 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,,,,•........... 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 $ �S
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 O 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
Specify 42 ❑ Public or private company 50. Total land area, sq. 4t. ...........
S
34 ❑ Other - p Jy
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 ElectriciJ> 44 Yes 45 1i No
L❑ _.__ 53. Number of bedrooms..............
38 Coal
39 ❑ Other - Specify Will there be an elevator? 54. Number of Full..........
-
46 1 Yes 47 I� No bathrooms
Partial.......
Date Filed File No.
ZONING PERMIT APPLICATION (510 .2)
1. Name of Applicant:
Address: 'c% ,'�. � c �,� Telephone:
2 . Owner of Property:
Address: 77c k z Telephone:
3 . Status of Applicant: Owner Contract Pur ha er
Lessee Other (explain: �� -F j
4 . Parcel Identification: Zoning Map Sheet# Parcel#
Zoning District(s) (include ove lays) (,//p C _
Street Address
Required
5. Existing Proposed by Zoning
Use of Structure/Property
(if project is only interior work, skip to #6)
Building height '
%B1dg.Coverage (Footprint)
Setbacks - front
side r
rear
Lot size
Frontage _
Floor Area Ratio
%Open Space (Lot area minus
building and parking)
Parking Spaces
Loading
Signs _
Fill (volume & location)
6 Narrative Description of Proposed Work/Project: (Use additior;al sheets
+SSA'i':«�+'j� } . _ ♦ 1 r `�
7. Attached Plans: Sketch Plan Site Plan
8. Certification: I hereby certify that the information contained herein
is true and accurate to the best of my knowledge.
Date: Applicant's Signature
- - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - -
THIS SECTION FOR OFFICIAL USE ONLY:
/Approved as presented/based on information presented
Denied as presented
Reason for Denial:
Signat a of BLi ding Ins or Date
4,-;y/YI
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