25C-008 (4) Vill. ZONING PLAN EXAMINERS NOTES
FRONT YARD
SIDE YARD SIDE YARD
IX. SITE OR PLOT PLAN For Applicant Use
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NOTES and Data — (For department use)
1 /
IV. IDENTIFICATION — To be completed by all applicants
Name Mailing address — Number, strret, city, and State ZIP code Tel. No.
Owner or
Lessee
Builder's
2. �. t �" 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
DO 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 Is
OTHER Is
V1. ADDITIONAL PERMITS REQUIRED OR OTHER JURISDICTION APPROVALS
Date 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 �j — ;� ) Use Group
Permit issued 4" 1 19
Building ,.�
Fire Grading
Permit Fee $ Live Loading
Certificate of Occupancy $ Occupancy Load
Approved by:
Drain Tile $
Plan Review Fee $ W or
TITLE
,. CITY OF NORTHAMPTON
�• MASSACHUSETTS
$ e OFFICE of the INSPECTOR oIf--�UILDINGS
Plot.
cur � Page APPLICATION FOR
INSPECTOR ZONING PERMIT AND
BUILDING PERMIT
z
IMPORTANT — Applicant to complete all items in sections: 1, 11, III, IV, and IX. O
n
l ZONING t
I• AT (LOCATION) / J �.tG. ` 7 / 'z DISTRICT
LOCATION (N0.) (STREET)
OF BETWEEN AND
BUILDING (CROSS STREET) (CROSS STREET)
LOT
SUBDIVISION LOT BLOCK SIZE
V1
II. 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 ❑ New building Re idential Nonresidential
Addition(If residential, enter number
2
❑ 12 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
3 Alteration (See 2 above)
number of unit"s— — —- --> 20 �� Industrial
�
14 Transient hotel, motel,
21 Forking 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 Carport 24 Office, bank, professional
6 ❑ Moving (relocation)
17 ❑� Other — Specify 25 ❑ Public utility
7 ❑ Foundation only
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,,,,,,,,,,,,,,,, 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 ..................... G t. c ' C"
c. Heating, air conditioning..........
d. Other (elevator, etc.).............
11. TOTAL COST OF IMPROVEMENT is
III. SELECTED CHARACTERISTICS OF BUII DING — 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
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 ❑ Oil conditioning? L. RESIDENTIAL BUILDINGS ONLY
37 C j Electricity 44 Yes 45 No
53. Number of bedrooms..............
38 ❑ Coal
39 ❑ Other — Specify Will -here be an elevators Full..........
_ 54. Number of
46 ❑ Yes 47 'J No bathrooms
Partial........
a DEPT:'+UF &iJILDING INSPECTIONS BUILDING ZO o
\�
212 Main Street O;i -�
Northampton, MA 01060 PERMIT <a
25C - 8 VALIDATION
DATE April 5. 19 88 PERMIT NO. 177
APPLICANT Gerald Arrhamhalllt ADDRESS. 171 West St. , West Hatfield 788
(N0.) (STREET) (CONTR'S LICENSE)
PERMIT TO Alteration (_) STORY One XX Family NUMBER OF
DWELLING UNITS
(TYPE OF IMPROVEMENT) NO. (PROPOSED USE)
AT (LOCATION) or reez ZONING URB
(NO.) (STREET) DISTRICT
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 remodel bathroom, remove fixtures, and reinstall and hang drywall
AREA OR 3,200.00 PERMIT 12.00
VOLUME ESTIMATED COST $ FEE .$
(CUBIC/SQUARE FEET)
OWNER Gerald Archambault, Sr. �r],�p� ��' '��.
ADDRESS 150 North St. , Northampton
WHITE - FILE COPY . GREEN - FIELD COPY ■ CANARY - APPLICANT COPY ■ PINK - ASSESSORS COPY pINT- p