35-157 (4) ZONING •
DISTRICT
FRONT YARD
SIDE YARD SIDE YARD
REAR YARD
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NOTES and Data — (For department use)
-�1�7
IV. IDENTIFICATION — To be completed by all applicants
Name Mailing address — Number, street, city, and State ZIP code Tel. No.
1.
Owner or �� j 21e�g , '�/
Lessee
�—+—r" — Builder's
2• � // l 1K 5 � License No.
Contractor 07 6-
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 applicatio s his authorized agent and we agree to conform to all applicable laws of this jurisdiction.
Signatu f a plic Address Application dollee-j
too
4 �a (�
DO NOT WRITE BE 0 THIS LINE
V. PLAN REVIEW RECORD — For office use
Plan Review Date Plans Date Plans
Plans Review Required Check Fee Started By Approved By Notes
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 By
BOILER PLUMBING
CURB OR SIDEWALK CUT ROOFING
ELEVATOR SEWER
ELECTRICAL SIGN OR BILLBOARD
M ACE STREET GRADES
ING USE OF PUBLIC AREAS
URNER WRECKING
R I I I OTHER
VII. VALIDATION
Building FOR DEPARTMENT USE ONLY
Permit number
Building Use Group
Permit issued t� ; Iq
Building Fire Grading
Permit Fee $ . " Live Loading
Certificate of Occupancy $ Occupancy Load
Approved by:
Drain Tile $
1,2
Plan Review Fee $
LE
CITY OF NORTHAMPTON
MASSACHUSETTS
$ e OFFICE of the INSPECTOR of BUILDINGS
1y}
Page % Plot 1 APPLICATION FOR
ZONING PERMIT AND
INSPECTOR BUILDING PERMIT
z
IMPORTANT — Applicant to complete all items in sections: 1, 11, Ill, IV, and IX. O
ZONING
AT (LOCATION) � DISTRICT
LOCATION (NO.)/ (STREET)
OF BETWEEN AND
BUILDING (CROSS STREET) (CROSS STREET)
LOT
SUBDIVISION LOT BLOCK SIZE
N
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
m
1 D New building Residg,6tial Nonresidential
20 Addition(If residential, enter number 12 One family 18 Amusement, recreational
of new housing units added, if any, 13 Two or more family — Enter 19 Church, other religious
in Part D, 13)
number of units— — — — ---)- 20 Industrial
3 O 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 ——————— — -- 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 C� Moving (relocation) p
17 Other — Specify 25 Public utility
7 Foundation only 26 n School, library, other educational
B. OWNERSHIP 27 L Stores, mercantile
8 I I Private (individual, corporation, 28 n Tanks, towers
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
10. Cost of improvement................ Y,��� �� 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.).............
it. 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 L] Masonry (wall bearing) 40 Public or private company
31 Wood frame 41 n 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
Specify 42 n Public or private company 50. Total land area, sq. ft. ...........
S
34 � Other — p Jy _
43 L_ Private (well, cistern) K. NUMBER OF OFF-STREET
PARKING SPACES
51. Enclosed .......................
F. PRINCIPAL TYPE OF HEATING FUEL 1. TYPE OF MECHANICAL
35 Gas Will there be central air 52. Outdoors........................
36 Oil conditioning? L. RESIDENTIAL BUILDINGS ONLY
37 C1 Electricity 44 Yes 45 - No 53. Number of bedrooms..............
38 Coal
39 Other— Specify Will there be an elevator? 54. Number of Full..........
46 --1 Yes 47 N bathrooms
o Partial........
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