25A-077 ZONING •
DISTRICT 03
iLIX. SITE OR PLOT
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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 / p
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.
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 $
V1. ADDITIONAL PERMITS REQUIRED OR OTHER JURISDICTION APPROVALS
ate Date
Permit or Approval Check ObOtai ed 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 DEPARTMENT USE ONLY
Permit number
Building Use Group
Permit issued .�� ' �� , _ 19
Building Fire Grading
Permit Fee $ ��•
Live Loading
Certificate of Occupancy $ Occupancy Load
Approved
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 sections: 1, 11, 111, IV, and IX. O
rlTi Q,
ZONING
I• AT (LOCATION) r r �X' DISTRICT
LOCATION IN 0.) EET)
OF BETWEEN .� ""Q AND
BUILDING (CROSS STREET) (CROSS STREET)
LOT
SUBDIVISION LOT BLOCK SIIZE�d�fpQ
iA
II. TYPE AND COST OF BUILDING — All applicants complete Parts A — D
A. TYPE OF IMPROVEMENT D. PROPOSED USE - For"Wrecking" most recent use rn
rn
1 New building R i ntial Nonresidential
2 Addition(1 residential, enter number
12 L One family 18 Amusement, recreational
of new housing units added, if any,
in Part D, 13) 13 Two or more fomily - Enter 19 Church, other religious
3 Alteration (See 2 above)
number of units- - -- -� 20 Industrial
�
_ 14 Transient hotel, motel, 21 Parking garage
4 Repair, replacement or dormitory - Enter number
5 Wrecking (If multifamily residential, of amts ------- --
22 Service station, repair garage
enter number of units in building in 15 Garage 23 Hospital, institutional
Part D, 13) r--
-1 16 Carport 24 �� Office, bank, professional
6 _ j Moving (relocation) ,,�
l 17 [l�] Other - Specify)&c�/, 25 r ] Public utility
7 ( Foundation only
26 �] School, library, other educational
B. OWNERSHIP 27 �L Stores, mercantile
8 ] Private (individual, corporation, 28 �_� Tanks, towers
nonprofit institution, etc.) 29 Other - Specify-
9 C:j 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•,,,•,•,•,•••,•, 4 o c- school, secondary school, college, parochial school, parking garage for
department store, rental office building office building at industrial plant.
7o be installed but not included 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 is
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 Public or private company 48. Number of stories................
Total square feet of floor area,
31 Wood frame 41 �� Private (septic tank, etc.) 49.
_ all floors, based on exterior G
32 n 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 L_II Private (well, cistern) K. NUMBER OF OFF-STREET
PARKING SPACES
51. Enclosed .......................
F. PRINCIPAL TYPE OF HEATING FUEL I. TYPE OF MECHANICAL
35 a Gas Will there be central air 52. Outdoors........................
36 _1 Oil conditioning? L. RESIDENTIAL BUILDINGS ONLY
37 �j Elec'1M•wai.T. t ..,,...t._,. 44 � �'es 45 ! No 53. Number of bedrooms..............
a
38 n Coal
39 Other - Specify Will there be an elevators �.� Full..........
- _ 54. Nuber of
46 Yes 47 D No bathrooms Partial........
� __
�'z
Y�
DEPT. 8F BUILDING INSPECTIONS BUILDING ZD
L 212 Main Street o<
Northampton, MA 01060 PERMIT
25A - 77 VALIDATION
DATE Sept. 12� 19_$$_ PERMIT NO.
APPLICANT Franri c I aRnca ADDRESS rja rnn' j W^ A,,P OwnPr
(N0.) (.TREY T) (CONTR'S LICENSE)
PERMIT TO (_1 STORY !Go! Shed NUMBER OF
DWELLING UNITS
T PE OF MPR VEMENT) N0. (PROPOSEO USE)
/ ,,M ZONING
Iv
AT (LOCATION) r� Midge Ave DISTRICT IIRB
(NO.) (STREET)
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. permit to repla ce existing tool shed/,* X 12'
AREA OR 48 sq. ft. 500.00 PE 10.00
VOLUME ESTIMATED COST F
(CUBIC/>fO UARE FEET)
Same as Applicant
OWNER Saffle as Applieamt's B
ADDRESS
WHITE - FILE COPY . GREEN - FIELD COPY • CANARY - APPLICANT COPY • PINK - ASSESSORS COPY pONtp