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FRONT YARD
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REAR YARD
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IV. IDENTIFICATION — To be completed by all applicants
Name Mailing address — Number, street, city, and State ZIP code Tel. No.
Owner or �, e D� MCA �«(00
Lessee
Builder's
1, 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.
Signature�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 Approval Check Obtai e a d Number By Permit or Approval Check Obtt t ed 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 p Use Group
Permit issued c� D 196
Building Fire Grading
Permit Fee $
Live Loading
Certificate of Occupancy $ Occupancy Load
Approved by:
Drain Tile $
Plan Review Fee $
TITLE
CITY OF NORTHAMPTON
MASSACHUSETTS
e OFFICE of the INSPECTOR of BUILDINGS
Page Plot APPLICATION FOR
INSPECTOR ZONING PERMIT AND
BUILDING PERMIT
z
IMPORTANT – Applicant to complete all items in I1 C n sections:: 11, 11, 111, IV, and IX. O ZONING
I• AT (LOCATION) t r� VIS�`F (,_2� L DISTRICT _
LOCATION ("O.) (STREE ' I r —
OF BETWEEN AND
BUILDING -� - _(CROSS STREET) CROSS STREET)
SUBDIVISION 1t� yY+�``- •�JSJ�-+5 LOT '� BLOCK SIZE
N
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 &6 New building Residential Nonresidential
2 Addition(If residential, enter number
12 � One family 18 � Amusement, recreational
of new housing units added, if any,
in Part D, 13) 13 Two or more family - Enter 19 Church, other religious
number of units- -- - - > 20 Industrial
3 � Alteration (See 2 above)
14 Transient hotel, motel, 21 Parking garage
4 Repair, replacement or dormitory - Enter number
5 ❑ Wrecking (11 multifamily residential, of units ------- - -i 22 L� Service station, repair garage
enter number of units in building in 15 Garage 23 Hospital, institutional
Part D, 13)
6 � Moving (relocation) 16 � Carport C 24 r� Office, bank, professional
17 Other - Specify )KG l ebaa�� 25 n Public utility
7 Foundation only
26 n School, library, other educational
B. OWNERSH)P y, on 27 Stores, mercantile
8 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,,,,,,,,••,,,... 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 $ do I
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 C Public or private company 48. Number of stories..............
31 I'll Wood frame 41 F-1 Private (septic tank, etc.) 49. Total square feet of floor area,
all floors, based on exterior
32 Structural steel dimensions ..................... [ �y
33 ❑ Reinforced concrete H. TYPE OF WATER SUPPLY
34 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
F. PRINCIPAL TYPE OF HEATING FUEL I. TYPE OF MECHANICAL 51. Enclosed ......................
35 Gas Will there be central air 52. Outdoors........................
36 Oil conditioning? L. RESIDENTIAL BUILDINGS ONLY
37 C j Electricity 44 Yes 45 r
No 53. Number of bedrooms..............
33 Coal
39 L J Other - Specify Will there be an elevators Full..........
54. Number of
46 Yes 47 'J No bathrooms
Partial.......
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