17A-240 (3) s
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CITY OF NORTHAMPTON 111ap No Lot
ZONING PERMIT APPLICATION ± e ��� �.6
Zoning Ordinance Section 10.2 t Re a Ko. Plan File
_P1~C,F BUILDING INSPECifiliS
010,
Owner 0J_QrA�� �5t- _Q�_- A� )l a �"
Address �c) � ��- �IC Address-1 �- `� - Fin
Telephone s�� '` ���� y 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 Proposed L------
Mark the appropriate box to indicate the use of the parcel:
❑ Non-Conforming Lot and/or Structure. Specify
❑ Residential ASingle Family Unit ❑Multi-Family
❑ Duplex ❑ Other
❑ Business
❑ Individual
• Institutional
❑ Regular ❑ P.U.D.
• Subdivision ❑ 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 Proposed
Loading Space Requirements: (Z.O. Sect. 8.2) Required Proposed
Signs: (Z.O. Art. VII) ❑ Yes ❑ No
Environmental Performance Standards: (Z.O. Art. X1 1) ❑ Yes ❑ No
Plot Plan ❑ Yes ❑ No Site Plan ❑ Yes ❑ No
(S. 10.2) (S. 10.2 and 10.11
Waiver Granted: Date ❑
Th ction for OFFICIAL use only:
Approval as presented:
Modifications necessary for approval:
❑ Return: (More information needed)
❑ Denial: Reasons:
Signature of Applica t Date Signature of Admin. Offic Date
P O
ZONING •
DISTRICT
REAR YARD 1�v rj_
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NOTES and Data — (For department use)
Le
IV. IDENTIFICATION — To be completed by all applicants
Name Mailing address — Number, stmt, city, and State ZIP code Tel. No.
I.
Owner or y'�
Lessee l 1 ��e
�.1 Builder's
2. 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.
Signatyyq of applicant Address Application dote
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
Fee Started y Approved y
BUILDING $
PLUMBING $
MECHANICAL $
ELECTRICAL $
OTHER $
VI. ADDITIONAL PERMITS REQUIRED OR OTHER JURISDICTION APPROVALS
Permit or Approval Check Date Number B Permit or Approval Check Date Number 8
Obtained y pp Obtained y
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 '{ J
Building Use Group
Permit issued J L)LA S 19 61
Building 01D Fire Grading
Permit Fee $ l0
Live Loading
Certificate of Occupancy $ Occupancy Load
Approved by:
Drain Tile $
s
Plan Review Fee $ i l
TITLE
CITY OF NORTHAMPTON
w f
g. MASSACHUSETTS
OFFICE of the INSPECTOR of BUILDINGS
�T
Page L ) �� Plot v APPLICATION FOR
I ZONING PERMIT AND
INSPECTOR BUILDING PERMIT
z
IMPORTANT — Applicant to complete all items in sections: 1, C)
'11, III,, IV, and IX. a
ZONING
I• AT (LOCATION)�j 3A- +ti (--c DISTRICT
LOCATION IN 0.) (STREET)
OF BETWEEN AND
BUILDING (CROSS STREET) (CROSS STREET)
LOT
SUBDIVISION LOT BLOCK SIZE
N
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 s! al Nonresidential
2 Addition(If residential, enter number 1 ne family 18 Amusement, recreational
of new housing units added, if any,
in Part D, 13) 13 [:�] Two or more family - Enter 19 n Church, other religious
number of units- - - - -I 20 Industrial
3 Alteration (See 2 above)
14 E] Transient hotel, motel, 21 �_� Parking garage
4 Repair, replacement or dormitory - Enter number
5 �_ Wrecking (It 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) 25 r Public utility
17 C� Other - Speci/y C_� y
7 Foundation only 26 School, library, other educational
B. OWNERSHIP 27 Stores, mercantile
6 Private (individual, corporation, 28 Tanks, towers
nonprofit institution, etc.) 29 Other - Specify
9 Public (Federal, State, or
local government)
C. COST (0snit 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 3C`,,f',• 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.)............. 7�f
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..............
49
31 Wood frame 41 F-1 Private (septic tank, etc.) . Total square feet floor area,
all floors, based on exterior
32 Structural steel dimensions .....................
33 Reinforced concrete H. TYPE OF WATER SUPPLY
34 El 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 n Oil conditioning? L. RESIDENTIAL BUILDINGS ONLY
37 CJ Electricity 44 [-] Yes 45 !_- No 53. Number of bedrooms..............
38 Coal
39 n Other - Specify Will there be an elevators 54. Number Full..........
-- ber of
46 _l Yes 47 �:] No bathrooms
Partial.......
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