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Da; e Filed -Ad, Z File No',
rorrxi•r�' �r�Tir�x� A1�1�7rxCI�(C:LO2t �.._...�,
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Zoning Or c1i11LI31aa a(Ibtion 10 , 2
Nye o i l��Ll i.c_���t ; �_ "__�L �1 ?Y�•�,SSt/
Address ; S3 �
Address , e 1 e p h o h e 1 �S�a+'►% _
3 si Orrnrr C'ontraci Purchaser
L,essce other (e,thl,ai ri )
q , P�r. oel Iclenti.f.tcal^,g t3 7on.,ng 14�1 p Sl1eat,'
Zoning District (s) _
Street AdCI� eSS X: �;�%� j-L,L f% _
5 , ' C.om liar ce' with to i, �c txi.-sr�t�i.ng Proposed
Use of Structure/Property
size of Structure (5cr . ft , )
Building height
N Building Coverage
'Setbacks - front 31st
r' - .side ay
{l - rear Vic:
Lot size
Fr. ontage
Floor Area Ilatio
k open Space
...Parking spaces _
L,oadiijg Spaces
signs
Fill (volume & location)
6„ Tar. ,atiGe Descri, ti.o of 'Pr. o -)osed work•Jpro� ect ; ( Usc
additi<dna�. s1lee�s if necessary)
' 7 , Attached P],ans ; . x sketch plain site Plan
p , cgrt'jf ieat.io-n 1 :[ hes:eby certify that tl�e 'ih ormation, contained
herein is true and accurate to the best o� my .knowledge ,
Date1 r � Applicant ' s Signatur.'e ;
Tx�s�s cTxoN—FOi��a 'r�:czn�, USE 5igT'1 i
V' Approved as presented
Denied as Presented,
Reason for Denial:
Signature off' S0ild.ing Xnspeetor. ,
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NOTE:IN ORDER THAT THIS APPLICATION MAY BE ACCEPTED,THE DATA CALLED FOR BELOW MUST BE SO SET FORTH THAT
WE CAN DETERMINE FROM THE APPLICATION AND THE ACCOMPANYING PLANS WHAT THE EXISTING CONDITIONS ARE AND
WHAT THE FUTURE CONDITIONS WILL BE.
Plans,in duplicate,must be filed with this application before a permit will be granted,one of which,upon issuance
of the permit shall be kept at the site during the progress of the work.
New...............W
Addition........❑
No.................-D, Zone..................., Type..................., Map..................... Parcel..................... Alterations ❑
Repair............❑
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y� CITY OF NORTHAMPTON Demolition....❑
MASSACHUSETTS
Application for other than a Dwelling Permit
(To be filled out in ink OR on a typewriter)
To the Building Inspector: Date............G:A..Ia....................... 19 `�/...
Application for a permit is hereby made according to the following:-
1. Location, Street and No..........5 ....A-�-te ...... .erx g.......R X?Atp....................................................
2. Nearest cross street.........FLaAw%4C.r...........Ra&�A ................................................. Lot No....................
3. Owner's name..............}�..1 .. t. �!,!.�.K.�............ es ePr�-
4. Architect's name................................ ..................................... Address .P!..0.'.A1 .... ......
5. Builder's name ............................................................................ Address .............................................................
6. Use of building, Present..................................... Proposed .........5 ................................................
7. Building fronts on how many Streets?.....................................................................................................................
8. Is building in fire district?........................................................................................................................................
9. Size of building,Width in ft. ........L2.................I Length in ft......../.G............., Height in ft........>>..............
10. Distance of building from Street Line.3 PA...., left lot line 1QC1.f�, right lot line r2 y. rear lot line...........
11. Type of construction(check one): l-A.......... 1-B .......... 1-C.......... II.......... III.......... IV.......... V..........
Stories B 1 2 3 4 5 6 7 Roof
Story heights in ft. I
Thickn's of walls in ins. 2.)C
Material of walls
Material of floor/roof w�
Design live load
Design dead load
Occupancy or Use 5/JLrr�
No.of persons/families tJ
No.of stairs v
12. Soil under footing is.......... . u'
................................................................................................................................
13. Depth of footing below grade.............4.`................ ft. Will piles be used?.........$.`.�..4'�"! " �✓.14. Area Area of entire building(Present plus new) .................../A.Y........................................................................ sq.ft.
15. Type of roof-flat...................... itched...... Material of roof covering , -
16. No.of elevators.............. Method of heating......&0.... System ................................. Fuel .................................
17. Are live loads noted on drawings? ............... Are all other structural conditions noted on drawings?...................
18. Building(will be)(is)equipped with sprinklers?................................. With sprinkler alarm?..............................
19. Is building to be used as a factory,workshop or mercantile or other establishment employing 10 or more persons?
...................................................................................................................................................................................
20. Is building to be used as an office building,dormitory,hotel,family hotel,apartment or boarding house,lodging
house or tenement house having 8 or more rooms above the second story?...........................................................
21. How many exits(per floor)to street? ......................................................................................................................
22. Is building a"Place of assembly"as defined by the General Laws? .......................................................................
23. Will building conform to the General Laws? ......................... Building and Zoning Ordinances?.........................
24. If a garage,distance from nearest building? ............................................................................................................
25. If an addition,alteration or demolition,when was building erected?......................................................................
26. Estimated costs:
/504.d e The undersigned certifies that the above statements are true to thebest
General$......................................... of TTTEN ge and belief.
Plumbing.........................................
...... ................................................
GasPiping....................................... nature f ner,architect or engineer
Sprinklers........................................ DISCR TTON OF WORK TO BE DONE
Heating............................................ (Use blank half of reverse side,if necessary)
Electric............................................ ............................................................,..................................................
Other............................................... ...............................................................................................................
Total$............................................ ...............................................................................................................
P^YNOP