12C-082 (6) YIII. ZONING PLAN EXAMINERS NOTES
DISTRICT
FRONT YARD
SIDE YARD SIDE YARD
REAR YARD
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NOTES and Data — (For department use)
b
i.
a
j
1
G
a
IV. IDENTIFICATION — To be completed by all applicants
Nome Mailing address — Number, street, city, and State ZIP code Tel. No.
. �f
owner or
Lessee
Builder's
2. N 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.
Signatur of plica t Address App IiC iO n da e
�t
00 NOT WRITE BELOW THIS LINE
V. PLAN REVIEW RECORD — For office use
Plans Review Required Check Plan Review Date Plans B Date Plans
Fee Started y Approved By Notes
BUILDING $
PLUMBING $
MECHANICAL $
ELECTRICAL $
OTHER $
VI. ADDITIONAL PERMITS REQUIRED OR OTHER JURISDICTION APPROVALS
Permit or Approval Check Date Number By Permit or Approval Check Date Number B
Obtained Obtained 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 � lf FOR DEPARTMENT USE ONLY
(,f
Building Use Group
Permit issued _ 19
Building Fire Grading
Permit Fee $ `(0'CC)
Live Loading
Certificate of Occupancy $ Occupancy Load
Approved by:
Drain Tile $ ;%
Plan Review Fee $
fl T4fE
r CITY OF NORTHAMPTON$[& r,?6 '416
�. MASSACHUSETTS
i e OFFICE of the INSPECTOR of BUILDINGS
�! Page v Plot �� APPLICATION FOR
�t
ZONING PERMIT AND
INSPECTOR BUILDING PERMIT
z
IMPORTANT — Applicant to complete all items in sections: 1, 11, 111, IV, and IX. yyy��� C)
ZONING
�.! �
I• AT (LOCATION) �/ ��� DISTRICT
LOCATION ('NO.) (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
1 F_� New building Residential Nonresidential
2 F] Addition(If residential, enter number 12 FV1 One family 18 Amusement, recreational
of new housing units added, if any,
in Part D, ]3) 13 Two or more family - Enter 19 � Church, other religious
number of units- - - - -i 20 n Industrial
3 Alteration (See 2 abo .) 14 Transient hotel, motel,
❑ 21 Parking garage
4 Repair, replacement or dormitory - Enter number
5 Wrecking (1/multifamily residential,
❑ of units ------- - --). 22 L_ 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� L-�
6 Moving (relocation) 25 Public utility
17 � Other - Specify
7 Foundation only 26 School, library, other educational
B. OWNERSHIP 27 Stores, mercantile
8 Private (individual, corporation, 28 n 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,,,,,,•,,....... "'may 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.....................
r
b. Plumbing .......................
c. Heating, air conditioning..........
d. Other(elevator, etc.).............
11. TOTAL COST OF IMPROVEMENT I$
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 SEWArva POSAL J. DIMENSIONS
48. Number of stories..............30❑ Masonry (wall bearing) 40 X Public or p company
31 Wood frame n p 49. Total square feet n floor area, v y�
41 Private (septic tank, etc.)
all floors, based on exterior
32 Structural steel dimensions .....................
33 Reinforced concrete H. TYPE OF WAjjF,,�YPPLY
34 Other - Specify
42 Public 'rrVV66yyrivote company 50. Total land area, sq. ft. ..........
43 J Private (well, cistern) K. NUMBER OF OFF-STREET
PARKING SPACES j
Sl. Enclosed .......................
F. PRINCIPAL TYPE OF HEATING FUEL 1. TYPE OF MECHANICAL
35 Gas Will there be central air 52. Outdoors........................
36 n Oil conditioning?
y� L. RESIDENTIAL BUILDINGS ONLY
37 �) Electricity 44 � y1C Yes 4S No 53. Number of bedrooms..............
38 Cool `�
39 Other - Specify Will-there be an elevator" Full..........
54. Number of
46 [_ ] Yes 47 I11 ' No bathrooms
�' Partial.......
DEPj...DFt11LDING INSPECTIONS BUILDING �O p
+ ! 212 Main Street Oa
Northampton, MA 01060 PERMIT
12C - 82 VALIDATION
DATE , imp 12 19 Rq PERMIT NO. ISO
APPLICANT lammg, A- Hardy ADORESS 1„Q arr r,ir Owner
(NO.) (STREET) (CONTR'S LICENSE)
PERMIT TO
Addition One Family NUMBER OF
UNITS
(_) STORY
(TYPE OF IMPROVEMENT) NO. (PROPOSED USE)
1g Marc Cir. ZONING URA
AT (LOCATION) DISTRICT
(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 for the addition of a deck 16'X27' X10'
AREA OR ESTIMATED COST $ 4,000.00 PERMIT $ 16.00
VOLUME
(CUBIC/SQUARE FEET)
OWNER Same as Applicant pp 6UILD1
ADDRESS Same as Alicant's BY
WHITE - FILE COPY . GREEN - FIELD COPY • CANARY - APPLICANT COPY • PINK - ASSESSORS COPY p0.1p