32C-311 (7) Vill. ZONING PLAN EXAMINERS NOTES
DISTRICT
USE
FRONT YARD
SIDE YARD SIDE YARD
REAR YARD
NOTES
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NOTES and Data — (For department use)
IV. IDENTIFICATION — To be completed by all applicants
Name ,q Mailing address ber, strcet, city, anti State ZIP code Tel. No.
Owner or
Lessee
Bui Ider's
2. License No.
Contractor
G70 J�/.0G1
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
� S
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 Permit or Approval Check Obtained 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 FOR DEPARTMENT USE ONLY
Permit number
Building. a^ Use Group
Permit issued 19 8'.?
Building `Qe Fire Grading
Permit Fee $ G
Live Loading
Certificate of Occupancy $ Occupancy Load
Approv by:
Drain Tile $ �,
Plan Review Fee $
TITLE
CITY OF •NORTHAMPTON
MASSACHUSETTS
• a
OFFICE of the INSPECTOR of BUILDINGS
Page 3)-r. Plot APPLICATION FOR
ZONING PERMIT AND
INSPECTOR BUILDING PERMIT
IMPORTANT — Applicant to complete items in sections: 1, 11, 111, IV, and IX. o
ZONING
I• AT (LOCATION) DISTRICT
LOCATION (NO.) (STREET)
OF BETWEEN AND
BUILDING (CROSS STREET) (CROSS STREET)
LOT
SUBDIVISION LOT BLOCK- SIZE
Vr
II. TYPE AND COST OF BUILDING — All 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(I/ residential, enter number 12 F-1 One family 18 ❑ Amusement, recreational
of new housing units added, if any,
in Part D, 13) 13 Se Two or more family - Enter 19 ❑ Church, other religious
number of units- - - - -� 20 ❑ Industrial
3 Alteration (See 2 above) 14 ansenoe , motel,
❑ Tr it htl tl 21 ❑ Parking garage
4 ❑ Repair, replacement or dormitory - Enter number
5 ❑ Wrecking (If multi family residential, of units ------- - -- 22 ❑ Service station, repair garage
enter number of units in building in 15 ❑ Garage 23 ❑ Hospital, institutional
Part D, 13)
6 ❑ Moving (relocation) 16 ❑ Carport 24 ❑ Office, bank, professional
7 ❑ Foundation only 17 E] Other - Specify 25 ❑ Public utility
26 ❑ School, library, other educational
B. OWNERSHIP . 011,11 27 ❑ Stores, mercantile
28 ❑ Tanks, towers
8 OK Private (individual, corporation, t- 29 ❑ Other - Specify
nonprofit institution, etc.)
9 ❑ Public (Federal, State, or
local government)
C. COST (Omit cents) Nonresidential - Describe in detail proposed use of buildings, e.g., food
Jprocessing plant, machine shop, laundry building at hospital, elementary
10. Cost of improvement,,,,,,,,,,,,,,,, 'yo 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.......... (1A
d. Other(elevator, etc.).............
11. TOTAL COST OF IMPROVEMENT $.gJ"
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 Pu61ic or private company
48. Number of stories......Z .......
31 Wood frame 41 Private (septic tank, etc.) 49. Total square feet of floor area, � at
all floors, based on exterior
32 ❑ Structural steel dimensions .....................
33❑ Reinforced concrete H. TYPE OF WATER SUPPLY
34 Other - Specify 42 FV7 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. TYPE OF MECHANICAL 51. Enclosed .......................
350 Gas Will there be central air 52. Outjoors........................
36 ❑ Oil conditioning?
L. RESIDENTIAL BUILDINGS ONLY
37 Electricity 44 Y 45 No
44 [] Yes � 53. Number of bedrooms..............
38 Coal
39 Other - Specify Will there be an elevator? Full../......
54. Number of
46 [_� Yes 47 V/1 No bathrooms
Partial.......
; BUILDING z
o �/r, 0
PERMIT
Ic VALIDATION
DATE � 19 f'ERMITRN E7
APPLICANT .�.. y Q Q✓ ADDRESS
a (NO.) (STREET)/ (CONTR'S LICENSE)
rl � ( ) STORY f �� s NUMBER OF
PERMIT TO �O«^it DWELLING UNITS
(TYPE OF IMPROVEMENT) NO. (PROPOSED USE)
1 01 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 FOUNDATION
(TYPE)
REMARKS:
AREA OR ESTIMATED COST $ .2 FEEMIT
VOLUME
(CUBIC/SOU f FEET) (�( //y�'�
OWNER li(JM) BUILDING Dp."R*G,
ADDRESS 5- BY C-�
WHITE - FILE COPY GREEN - FIELD COPY CANARY - APPLICANT COPY • PINK - ASSESSORS COPY