36-156 (2) Vill. ZONING PLAN EXAMINERS NOTES
FRONT YARD
SIDE YARD SIDE YARD
REAR YARD
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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
Lessee
Builder's
2. 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.
Signot e f applica Address Applica ion d e
7
00 NOT WRITE BELOW THIS LINE
KFI
LAN REVIEW fECORD — For office use
Ions Review Required Check Plan Review Date Plans B Date Plans B Notes
q Fee Started y Approved y
BUILDING $
PLUMBING $
MECHANICAL $
ELECTRICAL $
OTHER $
VI. ADDITIONAL PERMITS REQUIRED OR OTHER JURISDICTION APPROVALS
Doe 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 I FOR DEPARTMENT USE ONLY
Permit number �G
Building Use Group
Permit issued 19
Building Fire Grading
Permit Fee $ �� Live Loading
Certificate of Occupancy $ Occupancy Load
Approved by:
Drain Tile $
Plan Review Fee $ `�
CITY OF NORTHAMPTON
�+ e MASSACHUSETTS
OFFICE of the INSPECTOR of BUILDINGS
Page ) Plot � � APPLICATION FOR
INSPECTOR ZONING PERMIT AND
BUILDING PERMIT
z
IMPORTANT — Applicant to com all items in sections: 1, II, 111, IV, and IX. O
x ZONING
I• AT (LOCATION) '*' DISTRICT
LOCATION N0.1 (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 ® w building Residential Nonresidential
2 Addition residential, enter number
❑ / 12-jit One family 18 ❑ Amusement, recreational
of new housing units added, if any,
in Part D, 13) 13 Two or more family - Enter 19
3 Church, other religious
number of units- - -- -- 20 n Industrial
❑ Alteration (,See 2 above)
14 ❑ Transient hotel, motel, 21 Parking garage
4 Repair, replacement or dormitory - Enter number
5 ❑❑ Wrecking (1l multi family residential, of units ------- - --�— 22 L] Service station, repair garage
enter number of units in building in 15 Garage 23 L❑ Hospital, institutional
Part D, 13)
16 Carport 24 Office, bank, professional
6 Moving (relocation)
17 Other - Specify 25 Public utility
7 ❑ Foundation only 26 L� School, library, other educational
B. OWNERSHIP 27 L_ Stores, mercantile
8 rivate (individual, corporation, 28 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
Cl�✓ d 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 ,l If use of existing building is being charged, enter proposed use.
in the above cost
a. Electrical.......................
b. Plumbing .......................
c. Heating, air conditioning.......... ''
d. Other (elevator, etc.)............
11. TOTAL COST OF IMPROVEMENT $ f
III. SELECTED CHARACTERISTICS OF BfJIL6ING - For new buildings and additions, complete Parts E - L; 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 Public or private company Number of stories..............
49. Total square feet of floor area, O
31 Wood frame 41 Private (septic tank, etc.) �i
all floors, based on exterior r
32 Structural steel dimensions .....................
33 ❑ Reinforced concrete H. TYPE OF WATER SUPPLY $,
50. Total land ores, sq. ft. ...........
34 jr—] Other - Specify 42 Public or P rivate company
43 t Private
(well, cistern) K. NUMBER OF OFF-STREET
PARKING SPACES j
51. Enclosed ....................... L/
F. PRINCIPAL TYPE OF HEATING FUEL I. TYPE OF MECHANICAL
35 ❑ Gas Will there be central air 52. Outdoors........................ 'L_...,
36 Oil conditioning?
L. RESIDENTIAL BUILDINGS ONLY
37 Electricity 44 Yes 45 - No 53. Number of bedrooms..............
38 Coal /f
39 Other - Specify Will there be an e evotoro Full.......... �L
54. Number of
46 [_� Yes 47X I No bathrooms
Partial......
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