17D-007 (3) VIII. ZONING PLAN EXAMINERS NOTES
DISTRICT
FRONT •
SIDE YARD ,
REAR YARD
NOTES
IX. SITE OR PLOT PLAN For Applicant
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NOTES and Data — (For department use)
IV. IDENTIFICATION — To be completed by all applicants
Name Mailing oddressl .N'umbcr, struct, citN, crud staff, ZIP coded Tel. No.
7
Lessee
2 Builder's
-SJ ►j 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 tb conform to all applicable laws of this jurisdiction.
Signatuie of apptic)pnt Address Application date
zz
J gar i/�
DO NOT WRITE BELOW THIS LINE
V. PLAN REVIEW RECORD — For office use
Plans Review Required Check Plan Review Dote(Plans By Plans B Notes
Fee Stoned Y Approved Y
BUILDING
PLUMBING ---',
MECHANICAL
ELECTRICAL
OTHER —
VI. ADDITIONAL PERMITS REQUIRED OR OTHER JURISDIICTION APPROVALS
Permit or Approval Check Date Number B Permit or Approval Check Date Number B
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 j WRECKING
OTHER OTHER
VII. VALIDATION
Building
Permit number 249
Building
Permit issued ,june 20, 19 .
Building
Permit Fee 10 nn
Certificate of Occupancy S
Approved y-
Drain Tile
Plan Review Fee _
TDCAI, TNSPECMR
TITLE
of Nart alliptnn Lo
$ � �I�ssschitset#s
Office of the �Jnsvtrtox of 'Puilbings APPLICATION FOR
ZONING PERMIT AND
Page_/_7D_P1ot_7 BUILDING PERMIT
z
IMPORTANT — Applicant to complete all items in sections: 1, 11, III, IV, and IX. O
,A _ 1 ZONING
I• AT (LOCATION) -" �� �f� DISTRICT
y, � ( /
LOCATION (NO.) (STREET)li
OF BETWEEN (CROSS STREET)
BUILDING (CROSS STREET) AND
LOT F�
SUBDIVISION LOT BLOCK SIZE YY'
y
II. TYPE AND COST OF BUILDING — All applicants complete Parts A — D
M
A. TYPE OF IMPROVEMENT D. PROPOSED USE - For"Wrecking" most recent use M
1 KNew building Residential Nonresidential
2 ❑ Addition(If residential, enter number 12 ❑ One family 18 ❑ Amusement, recreational
of new bousing units added, if any, 19 Church, other religious
in Part D, 13) 1 3 � Two or more family - Enter 9
number of units- - - - --> 20 Industrial
3 ❑ Alteration (See 2 above) 14 Transient hotel, motel,
21 Parking garage
4 ❑ Repair, replacement or dormitory - Enter number
5 F-1 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 F-1 Moving (relocation)relocation) 17& Other - Speci/y 25 Public utility
7 F__] Foundation only f� 26 School, library, other educational
B. OWNERSHIP' 27 Stores, mercantile
28 Tanks, towers
8 dPrivate (individual, corporation,
nonprofit institution, etc.) 29 Other - SpeciJy
9 F-] 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 °'
7"(, school,) 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 - b
J, era
a. Electrical..................... ?
b. Plumbing ..................... ] l
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. y
Q
E. PRINCIPAL TYPE OF FRAME G. TYPE OF SEWAGE DISPOSAL J. DIMENSIONS Ri
48. Number of stories...............
30 Masonry (wall bearing) 40 Public or private company
41 Private (septic tank, e ) 49. Total square feet floor area,
i tc.
31 �Wood frame all floors, based on exterior
32❑ Structural steel dimensions .....................
33❑ Reinforced concrete H. TYPE OF WATER SUPPLY
50. Total land area, sq. ft. ...........
34 Other - Specify 42 Public or private company
43 ❑ Private (well, cistern) K. NUMBER OF OFF-STREET
PARKING SPACES
51. Enclosed ....................... O
F. PRINCIPAL TYPE OF HEATING FUEL I. TYPE OF MECHANICAL 0
35 Gas Will there be central air 52. Outdoors........................
36 ❑ Oil conditioning? L. RESIDENTIAL BUILDINGS ONLY
37 ❑ Electricity 44❑ Yes 454< No 53. Number of bedrooms..............
38 ❑ Coal
39 ❑ Other - Specify 1^L,ne. Will there be an elevator? 54. Number of Full..........
46 ❑ Yes 47❑ No bathrooms Partial........
i
I hereby certify that the proposed work s authorized by-the owner of record
and I have been authorized by the owler to make this-application as his
authorized agent.
SIGNATUi2 OF` AGENT
ADDRESS
(NUMBER) (SIRE T) (CITY)
APPROVED BY TITLE
DATE i9
DEPT. FILE COPY
ZO
CITY OF NORnV MPTON BUILDING a
NORTHAMPTON, MASS. PERMIT VALIDATION
DATE Jung 20- 19�_ PERMIT NO. 2
APPLICANT ThA &SSar.>Mbly of God Church ADDRESS n Rrid T ad9 Nnrth"PUn
(N .)r,R TREET)Rn (CONTR'S LICENSE)
NUMBER OF
PERMIT TO _) STORY DWELLING UNITS i +rnh
TYPE OF IMPROVEME N0. ROPOSED USE)
CQ ZONING
(N0.) RR
AT (LOCATION) 01 RriAge ]I(STREET) DISTRICT
:
a BETWEEN AND
m (CROSS STREET) (CROSS STREET)
m
LOT
a SUBDIVISION LOT BLOCK SIZE
m
0 BUILDING IS TO BE FT. WIDE BY FT. LONG BY FT. IN HEIGHT AND SHALL CONFORM IN CONSTRUCTION
O
M
O
Z TO TYPE USE GROUP BASEMENT WALLS OR FOUNDATION
(TYPE)
IL REMARKS: S Alragia of nhirch ATAizment�and gsap,lien
AREA OR PERMIT A
VOLUME ESTIMATED COST FEE $ i a 00
(CUBIC/SQUARE FEET)
OWNER The Assembly of Church BU I T
ADDRESS _�5 >'0 Bxi ge Roads Northampton BY
(Affidavit on reverse side of application to be completed by authorized agent of owner)