29-062 (5) ZONING
DISTRICT
1 USE
FRONT YARD
SIDE YARD SIDE YARD
REAR YARD
IX. SITE OR PLOT PLAN For Applicant Use
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NOTES and Data — (For department use)
r 1
IV. IDENTIFICATION — To be completed by all applicants
Name Mailing address — Number, street, city, and State ZIP code Tel. No.
��1� G - z
Owner or � � 0 1046ZG' S.
Lessee
Builder's
2. :'L 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.
Signotu a 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 B Notes
9 Fee Started y Approved y
BUILDING $
PLUMBING $
MECHANICAL $
ELECTRICAL $
OTHER
VI. ADDITIONAL PERMITS REQUIRED OR OTHER JURISDICTION APPROVALS
Date D
Permit or Approva I Check Obtained Number By Permit or Approval Check Obtained t 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 Use Group
Permit issued `� ' tl ' g 19
Building Ql7 Fire Grading
r
Permit Fee � 45- 4 Live Loading
Certificate of Occupancy $ Occupancy Load
Approved by:
Drain Tile
Plan Review Fee $ '�
TITLE
aCITY OF NORTHAMPTON
�* N �«� MASSACHUSETTS
$ OFFICE of the INSPECTOR of BUILDINGS
,YT Page C� Plot APPLICATION FOR
INSPECTOR ZONING PERMIT AND
BUILDING PERMIT
z
IMPORTANT — Applicant to complete all items in sections: 1, 11, 111, IV, and IX. VV Y1.
I• AT (LOCATION) 7 `� (48 1/u / �� �4o ' DISTRICT l"t
DISTRICT /�-!ll��/
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(1/ residential, enter number 12 F-1 One fomi ly 18 Amusement, recreational
of new housing units added, if any,
in Part D, 13) 13 D Two or more family — Enter 19 Church, other religious
3 Alteration (See 2 above)
number of units— — — — --> 20 Industrial
�
14 Ej Transient hotel, motel, 21 Parking garage
4 Repair, replacement or dormitory — Enter number
5 n Wrecking (1l 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 E] Carport 24 �_ � Office, bank, professional
6 Moving (relocation)
7 Foundation only 17 �� Other — Speci/ 25 C� Public utility
7S 26 n School, library, other educational
B. OWNERSHIP 27 ❑ Stores, mercantile
8 Private (individual, corporation, %/_ / /►c)6 28 L J Tanks, towers
nonprofit institution, etc.) ((J 29 Other — Specify
9 n 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................ �r school, secondary school, college, parochial school, parking garage for
department store, rental office building, office building at industrial plant.
7'o 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
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 l Public or private company 48. Number of stories................
31 n Wood frame 41 D 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 n Other — Specify 42 n Public or private company 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 L Gas Will there be central air 52. Outdoors........................
36 Oil conditioning"�
_ L. RESIDENTIAL BUILDINGS ONLY
37 Electricity 44 'I Yes 45 No 53. Number of bedrooms..............
38 Coal
39 Other — Specify Will there be an elevator° Full..........
54. Number of
46 Yes 47 :j No bathrooms
Partial.......
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