17C-015 (3) .......
-Vill. ZONING PLAN EXAMINERS NOTES
DISTRICT
FRONT YARD
SIDE YARD SIDE YARD
REAR YARD
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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.
Owner or
Lessee
CQ/�O Builder's
2
7 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 a authorized agent and we agree to conform to all applicable laws of this jurisdiction.
Signatu` app/ca I Address Application date
L� 00 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 $
V1. 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 FOR DEPARTMENT USE ONLY
Permit number
Bui(ding
Permit issued 19 t,t r;' Use Group
Building Fire Grading
Permit Fee �t
Live Loading
Certificate of Occupancy
Occupancy Load
A ved by:
Drain Tile
Plan Review Fee $
TITLE
CITY OF NORTHAMPTON
�• MASSACHUSETTS
r
$ e OFFICE of the INSPECTOR of BUILDINGS
„„
1 . Page 17C- 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
ZONING
`ry}r.
I• AT (LOCATION) `"� 7 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
m
1 ❑ New building Residential Nonresidential
2 Addition(IJ residential, enter number 12[L;�6ne 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- - - - -
3 F-1 Alteration (See 2 above) -)� 20❑ Industrial
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)
7 ❑ Foundation only 17 ❑ Other - Specify 25❑ Public utility
n 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 .....................
c. Heating, air conditioning.........
d. Other(elevator, etc.).............
11. TOTAL COST OF IMPROVEMENT $
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
32 ❑ Structural steel dimensions .....................
33 ❑ Reinforced concrete H. TYPE OF WATER SUPPLY
34 ❑ Other - Specify 42 ❑ Public or private company 50. Total land urea, 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 o
❑ N 53. Number of bedrooms..............
38 ❑ Coal
39 L1 Other - Sped%y Will there be an elevator? Full..........
54. Number of
46 C Yes 47 a No bathrooms
Partial........
Department of Building Inspections BUILDING
212 Main Stree# �°-
Northampthn, Ma, 01060 P��lvtl�" as
17C - 15 VALIDATION
DATE Fohrl/Ary 1 5_ 19 83 PERMIT NO. 77
APPLICANT ftcoy s ADDRESS— 030719
.)
(NO STREET) (CONTR'S LICENSE)
NUMBER OF
PERMIT TO (_) STORY DWELLING UNITS ,
E F M RENT) NO. P OPOSED USE
ZONING
AT (LOCATION) �7 Take DISTRICT ITRS
(NO.) (STREET)
BETWEEN AND
(CROSS STREET) (GROSS 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:
AREA OR PERMIT
VOLUME ESTIMATED COST $4625 00 FEE $_ ?n nA.
(CUBIC/SQUARE FEET)
i
OWNER
BUILDING
ADDRESS BY
WHITE - FILE COPY . GREEN - FIELD COPY e CANARY - APPLICANT COPY • PINK - ASSESSORS COPY