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NOTES and Data — (For department use)
ZONING •
FRONT YARD
L SIDE YARD f SIDE YARD
REAR YARD
IX. SITE :r s
OR Applicant
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1 a t�■:�fN■N ar"41a•:' :: $H :: a.H faN:N Met�N:•f� /.■�N/�:4141� ■4141: •4141:.•rt: • •I:.NaH::41:•�:: :::414141::N::.::::::41:::::■:H■.R:■a:H•:::::::::::::::•::::
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::t a ii $■4141 • t.N a H ■ Ha415 o•u.H:R ■H•urrHHH■HSH H. uumHNHHUCUGH■.■:HUU•NNHH• •NUH.••:..•8
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t .s.
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IV. IDENTIFICATION = To be completed by all applicants
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 ap tion as his authorized agent and we agree to conform to all applicable laws of this jurisdiction.
5Lig.2,ature of a plican Address `7 Application date
D0 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 Date
Permit or Approval Check Obta ned 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 Use Group
Permit issued 19U
Building Fire Grading
Permit Fee $ WOM
Live Loading
Certificate of Occupancy $ Occupancy Lood
Aped by:
Drain Tile $
Plan Review Fee $
TLE�
r JNt P
CITY OF NORTHAMPTON
�• .e �. MASSACHUSETTS
OFFICE of the INSPECTOR of BUILDINGS
Page Plot t
�� APPLICATION FOR
INSPECTOR ZONING PERMIT AND
BUILDING PERMIT
IMPORTANT — Applicant to complete.. all items in sections: 1, 11, 111, IV, and IX. O
1 y� I�'uiS ?L4 LtL�^ ZONING
I• AT (LOCATION) r `f DISTRICT
LOCATION (NO.) 5 REET)
OF BETWEEN AND
BUILDING (CROSS STREET) (CROSS STREET)
LOT
SUBDIVISION LOT BLOCK SIZE
V1
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 E New building R si ential Nonresidential
2 [Addition(IJ residential, enter number 12 one family 18 Amusement, recreational
of new housing units added, if any,
in Part D, ]3) 13 wo 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 (If multifamily residential, of units ——————— — - 22 ❑ Service station, repair garage
enter number of units in building in 15 Garage 23 J Hospital, institutional
Part D, 13) 16 Carport 24 Office, bank, professional
6 n Moving (relocation)
7 n Foundation only 17 ❑ Other — Specify 25 Public utility
26 n School, library, other educational
B. OWNS HIP 27 Stores, mercantile
( 28 C� Tanks, towers
8 Private (individual, corporation, YYl — S
nonprofit institution, etc.) 2g Other Specify
+ �_� P fy
9 [:7] Public (Federal, State, or
local government)
C. COST (Omit cents) Nonresidential — De tribe in detail prop ed use of buildings, e.g., food
processing plant, machine shop, laundry building at hospital, elementary
10. Cost of improvement•,••,••••••.,.•, �_ L')00, 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.)............. r'
11. 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 V.
E. PRINCIPAL TYPE OF FRAME G. TYP�EWAGE DISPOSAL J. DIMENSIONS L
48. Number of stories.............. t
30 M onry (wall bearing) 40 Public or private company
31 Wood frame 41 n Private (septic tank, etc.) 49. Total square feet n floor or
all floors, based on exterior i
32 Structural steel dimensions ..................... 11Z „
33 Reinforced concrete H. TYP�F WATER SUPPLY
50. Total land area, sq. ft. ,,........
34 Other — .Specify 42 C Public or private company
43 ❑ Private (well, cistern) K. NUMBER OF OFF-STREET
PARKING SPACES
F. PRINCIPAL TYPE OF HEATING FUEL 1. TYPE OF MECHANICAL 51. Enclosed ....................... S
35 7G As Will there be central air 52. Outdoors........................ o+�
?
conditioning
36 � Oil � L. RESIDENTIAL BUILDINGS ONLY
37 L j Electricity 44 Yes 45 No
-- ' 53. Number of bedrooms..... .......
38 Coal
39�� Other — Specify Will there be an elevotor� Full. ...
54. Nurn ber of
46 Yes 47I bathrooms
Partial......
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