25A-157 (9) ZONING •
FRONT DISTRICT
SIDE YARD SIDE YARD
REAR YARD
NOTE S
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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.
1.
(Jlflf✓(J
Owner or
Lessee
' Builder's
L. i.41,d1 � r9 1`ti
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.
Signatu7 a plicant Address Application date
D0 NOT WRITE BELOW THIS LINE
V. PLAN REVIEW RECORD — For office use
Plans Review Required Check Plan Review Date Plans By Date Plans By Notes
Fee Started Approved
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
II. VALIDATION
Building 7 FOR DEPARTMENT USE ONLY
Permit number /
Building. Use Group
Permit issued 19
Building / Fire Grading
Permit Fee $ L V'^'/
Live Loading
Certificate of Occupancy $ Occupancy Load
A ved by:
Drain Tile $
Plan Review Fee $ ` I
TITLE
CITY OF NORTHAMPTON
9' MASSACHUSETTS
OFFICE of the INSPECTOR of BUILDINGS
Page ��� P 1 o t l4-7
APPLICATION FOR
ZONING PERMIT AND
INSPECTOR BUILDING PERMIT
IMPORTANT fy- Applicant to complete a// items in sections: 1, 11, 111, IV, and IX. o
I. l3 / ,/J J► ZONING TWR
AT (LOCATION) C7 i"bv" DISTRICT Y
LOCATION (NO.) `STREET)
OF BETWEEN AND
BUILDING (CROSS STREET) (CROSS STREET)
LOT
SUBDIVISION LOT BLOCK SIZE
H
II. TYPE AND COST OF BUILDING - All applicants complete Ports A - D -�
A. TYPE OF IMPROVEMENT D. PROPOSED USE — For"Wrecking" most recent use m
M
1 ❑ New building Residential Nonresidential
2 Addition(! residential, enter number ❑
f 12 One family 18 Amusement, recreational
of net, housing units added, if any,
in Part D, 13) 13 Two or more family — Enter 19 ❑ Church, other religious
number of units— — — — 20 ❑J 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 `❑ Hospital, institutional
Part D, 13) 16 �❑ p
Car ort 24 �❑ Office, bank, professional
6 �] Moving (relocation)
7 ❑ Foundation only 17 E:] Other — Specify ' 25 ❑ Public utility
�� 26 ❑ School, library, other educational
B. OWNERSHIP �_ 27 ❑� Stores, mercantile
8 Private (individual, corporation, 28 ❑ Tanks, towers
nonprofit institution, etc.) 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,,,,,,,,,,,,,,,, `'S-6-c; 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.)............. -y
11. TOTAL COST OF IMPROVEMENT Is ��ce,
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.........
31 Wood frame 41 ❑ Private (septic tank, etc.) 49. Total square feet of floor area,
all floors, based on exterior
Structural steel dimensions .....................
32 L
33 Reinforced concrete H. TYPE OF WATER SUPPLY
34 ❑—
Other — .Specify 42 V 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. >Ye CHANICAL
35 ❑ Gas central air 52. Outdoors.......................
36 Oil
L. RESIDENTIAL BUILDINGS ONLY
37 C Electricity 5 No 53. Number of bedrooms..............
38 ❑ Co al Sect n elevator?39 ( Other — 1 Jy Full....54. Number of
47 I�] No bathrooms Partial........
{ hereby certify that the ptoposed'.work is authorized by the owner of record ..
and I have been authorized by the owner to make-this-application as his
authorized agent.
SIGNATURE OF AGENT _. .
ADDRESS
(NUMBER) (STREET) (CITY) '
APPROVED BY TITLE
DATE 19
/fns DEPT. FILE COPY
G� 0
o
i BUILDING OaJ
�J8 .�../ _7 PERMIT VALIDATION
LLL
�//�/► DATE 19 P E R/jv(}��)T NO.
APPLICANT �"� ADORES
a(N O.) (STREET) (CONTR'S LICENSE)
1
NUMBER OF
PERMIT TO (_) STORY DWELLING UNITS
(TYPE OF IMPROVEMENT) NO. (PROPOSED USE)
ZONING (,/
AT (LOCATION) DISTRICT -L
SCA-
(NO. (STREET)
a BETWEEN AND
u (CROSS STREET) . (CROSS STREET)
A
LOT
IL SUBDIVISION LOT BLOCK SIZE
m
u BUILDING IS TO BE FT. WIDE BY FT. LONG BY FT. IN HEIGHT AND SHALL CONFORM IN CONSTRUCTION
O
Z TO TYPE USE GROUP BASEMENT WALLS OR FOUNDATION
(TYPE)
I
a
0
LL REMARKS'
AREA OR ESTIMATED COST $L �— FEEMIT d
VOLUME
(CUBIC/SQUARE FEET)
OWNER BU
ADDRESS B
(Affidavit on reverse side of application to be completed by authorized agent of owner)