25A-048 (8) ZONING •
FRONT YARD
SIDE YARD SIDE YARD
REAR YARD
NOTES
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NOTES and Data — (For department use)
IV. IDENTIFICATION — To be completed by all applicants '
Nam Mailing address — Number, street, city, and State ZIP code Tel. No.
1.
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.
=Signaturplic nt � Address Application date
l
NOT WRITE B EkO W THIS LINE
V. PLAN REVIEW RECORD — For office use
Plans 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
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 FOR DEPARTMENT USE ONLY
Permit number
Building Use Group
Permit issued 19 _
Building Fire Grading
CO•�
Permit Fee $ Live Loading
Certificate of Occupancy $ Occupancy Load
$ Approved by:
Drain Tile ���1 ✓�,(�/� ��`L`r>t �-.
Plan Review Fee $
TITLE
CITY OF NORTHAMPTON
�• MASSACHUSETTS
OFFICE of the INSPECTOR of BUILDINGS
t Page Plot IT APPLICATION FOR
INSPECTOR ZONING PERMIT AND
BUILDING PERMIT
z
IMPORTANT — Applicant to complete all items in sections: I, 11, Ill, IV, and IX. O
ZONING
I• AT (LOCATION) -- _ DISTRICT
LOCATION (N0.) (STREET)
OF BETWEEN AND
BUILDING (CROSS STREET) (CROSS STREET)
LOT
SUBDIVISION LOT BLOCK SIZE
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 Residential Nonresidential
2 Addition(If residential, enter number
12 F-1 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
30 Alteration (See 2 above)
number of units— — — — --► 20 n Industrial
_ 14 L� Transient hotel, motel, 21 Parking garage
4 Repair, replacement or dormitory — Enter number 22 Service station, repair garage
5 C� Wrecking (If multifamily residential, of units ——————— — -- �._
enter number of units in building in 15 Garage 23 Hospital, institutional
Part D, 13)
16 Corpora 24 n Office, bank, professional
6 Moving (relocation)
17 Other — Speci/y 25 Public utility
7 Foundation only
Lo
coo �� School, library, other educational
B. OWNERSHIP Lorna STOIZA.G''st 27 Stores, mercantile
8 Fl l Private (individual, corporation, 28 Tanks, towers
nonprofit institution, etc.) 29 n Other — Specify__
9 ❑ Public (Federal, State, or
local government)
C. COST (Omit cents) Nonresidential — Describe in detail proposed use of buildings, e.g., food
h�y processing plant, machine shop, laundry building at hospital, elementary
10. Cost of improvement,••••••,•.,..... 7e+� 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
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
Z.
30 L] Masonry (wall bearing) 40 Public or private company 48. Number of stories..............
31 Wood frame 41 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
34 Other — Specify 42 Public or private company 50. Total land area, sq. fT. ...........
43 ❑ Private (well, cistern) K. NUMBER OF OFF-STREET
PARKING SPACES
51. Enclosed .......................
F. PRINCIPAL TYPE OF HEATING FUEL I. TYPE OF MECHANICAL
35 [:] Gas Will there be central air 52. Outdoors........................
36 WOil conditioning?
L. RESIDENTIAL BUILDINGS ONLY
37 F_) Electricity 44 Yes 45 No
❑ 53. Number of bedrooms..............
38 Coal
39 Other — Specify Q16040 Will there be an elevator? Ful''..........
F 54. Number of
46 I j Yes 47 Xj No bathrooms
- Partial.......
a DEPT. O, BUILDING INSPECTIONS
BUILDING
212 Main Street O<
• Northampton, MA 01060 PERMIT <a
25A - 48 VALIDATION
DATE August 24. 19_87 PERMIT NO. 571
APPLICANT CnrnthT Kp-jlal/ ADDRESS �trPPt. Owner
IN0.1 (STREET) (CONTR'S LICENSE)
NUMBER OF
PERMIT TO N° B } �n (_) STORYnrgn�A ShP�j DWELLING UNITS
ITYP�` OF IM R V�ME A NO. (PROPOSED USE)
- ZONING
(NO.) ErPP� DISTR CT
AT (LOCATION) _4 G^nchv URB
BETWEEN AND
(CROSS STREET) (CROSS STREET)
LOT
SUBDIVISION LOT BLOCK SIZE
BUILDING IS TO BE FT. WIDE BY FT. LONG BY FT. IN HEIGHT AND SHALL CONFORM IN CONSTRUCTION
TO TYPE USE GROUP BASEMENT WALLS OR FOUNDATION
(TYPE)
REMARKS:
AREA OR 5500.00 PERMIT 10.00
.$
VOLUME ESTIMATED COST FEE
(CUBIC/SQUARE FEET) j Q�
OWNER Same as Applicant /�}j►' �e"' ' "
ADDRESS Same as Applicant's :YIP
WHITE - FILE COPY . GREEN - FIELD COPY • CANARY - APPLICANT COPY • PINK -(/ASSESSORS COPY p ... P