25A-090 (8) Vill. ZONING PLAN EXAMINERS NOT
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NOTES
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NOTES and Data — (For department use)
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CITY OF NORTHAMPTON �_0 '°"® �'`� Lot �> U
ZONING PERMIT APPLICATION a Tax Map No.�
Zoning Ordinance Section 10.2 TIt Received: File No. Plan File
Owner
Applicant
,y
Address �-� � -�'�-- — Address
Telephone (/ Telephone
This section is to be filled out in accordance with the "Table of Dimensional and Density Regulations:
(Z.O. ARTICLE VI)
Zoning Use Lot Front Depth Setbacks Max. Bid. Min. Op.
District Area Width Front Side Rear Cover Space
Past Existing
Present//rea Proposed % %
Mark the appropriate box to indicate the use of the parcel:
❑ Non-Conforming Lot and/or Structure. Specify
Residential ASingle Family Unit ❑Multi-Family �b X 3
❑ Duplex Other
❑ Business
❑ Individual
❑ Institutional
❑
El Subdivision Regular El P.U.D.
❑ Cluster ❑ Other
❑ Subdivision with "Approval-Not-Required"-Stamp:
❑ Planning Board Approval:
• Zoning Board Approval (Special Permit 10.9: Variance)
• City Council (Special Exception S. 10.10)
Watershed Protection District Overlay: (Z.O. Sect. XIV) ❑ Yes No
Parking Space Requirements: (Z.O. Sect. 8.1) Required. ''Z= Proposed
Loading Space Requirements: (Z.O. Sect. 8.2) Required �_ roposed
Signs: (Z.O. Art. VII) ❑ Yes No
Environmental Performance Standards: (Z.O. Art. XI 1) ❑ Yes ANo
Plot Plan ❑ Yes XNo Site Plan ❑ Yes A No
(S. 10.2) (S. 10.2 and 10.11
Waiver Granted: Date ❑
This section for OFFICIAL use only:
yApproval as presented:
❑ Modifications necessary for approval:
❑ Return: (More information needed)
❑ Denial: Reasons:
Signature of Ap cant Date Sig f 'c Date
TH E.PR�Hi�.NG PRH55
IV. IDENTIFICATION — To be completed by all applicants
Name Mailing address — %'wobcr, s(rc•c•t, rich, m,l .Stntc ZIP code Tel. No.
Owner or C i /
Lessee
builder's
2. _ - License No.
Contractor
i
3.
Architect o r
- -----
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.
Sig ur o lican Address Application date
s
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
q 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
Permit number
Building
Permit issued el� 19�_
Building
Permit Fee
Certificate of Occupancy S
Approved b
Drain Tile S
Plan Review Fee _
1
LE
� � �Ixsst3cf)ixsctfs
T` Offire of the �ns}>ertnr of `Puilbings
APPLICATION FOR
ZONING PERMIT AND
Pages 1` Plot_ _ BUILDING PERMIT
IMPORTANT — Applicant to complete all items in sections: 1, 11, /it, IV, and IX. p
I •AT (LOCATION) l�t� `L®� IZ G—E_ A ,} ZONING
DISTRICT
LOCATION (NO.) (STREET)
OF AND
BUILDING BETWEEN (CROSS STREET) (CROSS STREET)
LOT
SUBDIVISION LOT BLOCK SIZE
II. TYPE AND COST OF BUILDING — All applicants complete Parts A — D m
A. TYPE OF IMPROVEMENT D. PROPOSED USE — For"Wrecking" most recent use M
1 ❑ New building Residential Nonresidential
2 ❑ Addition(If residential, enter number 12�One family 18 ❑ Amusement, recreational
of new housing units added, if any, 13 Two or more family — Enter 19 ❑ Church, other religious
in Part D, 13)
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 ------— — i 22 Service station, repair garage
enter number of units in building in 15 ❑ Garage 23 ❑ Hospital, institutional
Part D, 13) 16 Carport
24❑ Office, bank, professional
❑
6 ❑ Moving (relocation) 2 ❑
17X Other — Specify 5 Public utility
7 ❑ Foundation only 26 ❑ School, library, other educational
B. OWNERSHIP /��',CPoviyz_ 40� 27 ❑ Stores, mercantile
28 Tanks, towers
8 ❑ Private (individual, corporation, ❑
nonprofit institution, etc.) lik 3 �2__- 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................ 6 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.....................
vL/
b. Plumbing .....................
c. Heating, air conditioning..........
d. Other (elevator, etc.)............. s�
11. TOTAL COST OF IMPROVEMENT $ Cf
III. SELECTED CHARACTERISTICS OF BUILDING — For new buildings and additions, complete Parts E — L; ,D
for wrecking, complete only Part J, for all others skip to IV. y
E. PRINCIPAL TYPE OF FRAME G. TYPE OF SEWAGE DISPOSAL J. DIMENSIONS m
48. Number of stories...............
30❑ Masonry (wall bearing) 40 ❑ Public or private company
Private (se 49• Total square feet of floor area,
31 Wood frame 41 ❑ va (septic tank, etc.) all floors, based on exterior
32❑ Structural steel dimensions ..................... N
33 ❑ Reinforced concrete H. TYPE OF WATER SUPPLY
r 50. Total land area, sq. ft. ...........
34 ❑ 42 Public or company
Other — SpeciJy ❑ p R y
43 ❑ Private (well, cistern) K. NUMBER OF OFF-STREET
PARKING SPACES ,0
51. Enclosed ....................... r
F. PRINCIPAL TYPE OF HEATING FUEL 1. TYPE OF MECHANICAL O
35 ❑ Gas Will there be central air 52. Outdoors........................
36 ❑ Oil conditioning? L. RESIDENTIAL BUILDINGS ONLY
37 ❑ Electricity 44 ❑ Yes 45 ❑ No 53. Number of bedrooms..............
38 ❑ Coal
39❑ Other — Specify Will there be an elevator? 54. Number of Full..........
46 ❑ Yes 47 ❑ No bathrooms Partial.......
I hereby certify that the proposed work is authorized by the owner of record 4
and l have been authorized by the owner to make this application as his
authorized agent.
SIGNATURE OF AGENT'
ADDRESS
(NUMBER) (STREET) (C)TY)
APPROVED BY TITLE,
DATE 19
DEPT. FILE COPY
r ZO
BUILDING as
PERMIT VALIDATION
DATE 19 ,7- PERMIT NO. �(l
APPLICANT ADDRESS
(CONTR•S LICENSE)
�!//'''� NUMBER OF
PERMIT TO ���orn IMPROVEMENT) N0. (PROPOSED USE),!p A ( ) STORY DWELLING UNITS
AT (LOCATION) Aq e 2 66,e,Z,o!> - _6 A ZONING
., DISTRICT
(N0.) (STREET)
m BETWEEN AND
b (CROSS STREET) (CROSS STREET)
rn
LOT
m SUBDIVISION "� LOT BLOCK SIZE
a /qe"31 4XI
U
O B'VTEMING IS TO BE FT, WIDE BY L3 FT. LONG BY FT, IN HEIGHT AND SHALL CONFORM IN CONSTRUCTION
M
O
Z TO TYPE USE GROUP BASEMENT WALLS OR FOUNDATION
2 /t ,,...�A ) (TYPE)
LL REMARKS, "'f�az
AREA OR
VOLUME ESTIMATED COST $ FEE
MIT Q d
(CUBIC/SQUARE FEET)
OWNER �
BUI IN EPT. '
ADDRESS BY
{Affidavit on reverse side of application to be completed by d agent of owner