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Y (STREF (CONTR'S EwENSEl
J' I `/ NUMBER OF -
- PERMIT TO �N+� i_I STORY DWELLING UNITS
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AT (LOCATION) JJJJ �' _. -^" ..... ...... —_. OOS TR CT
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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
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Len. �/ �y/j] ITYPEI
REMARKS: Li J 41 X. li tt v Jl ri`-t . �.y�
AREA OR /6 e b �� �� PERMIT $ !QA CO
VOLUME___ ESTIMATED COST $ V FEE Ni
SQUARE FEET) •
--
OWNER '.rry � � BOIIAIN
ADDRESS BY LL
WHITE - FILE COPY . /PEN - FIELD COPY • CANARY - APPLICANT COPY * PINK - AS 54 SSORS COPY
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APPLICANT if RODPES4 IT I
IfiNEE (40xTB'b LICENSE/
(/� ML111 NUMBER OF ...mooPERMIT TO J (_,I ySTORY rDWELLING UNITS
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SUBDIVISION LOT BLOCK SIZE
BUILDING IS TO BE FT. WIDE BY FT. LONG fY FT. IN HEIGHT Moo SHALL CONFORM IN CONSTRUCTION
TO TYPE USE GROUP EASEMENT WALLS OR FOUNDATION -
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REMARKS: /41112 1"1:1 X !( J/ + •• '
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AREA OR / P p S•B� q
VOLUME / `x ESTIMATED COBB $ SO4 CMIT a /4. yQ
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OWNER A
Pr ADDRESS. Ahf_ f UIWi
BBUILD.
WHITE - FILE COPY . /E EN - FtELIA COPY • CANARY - APPLICANT COPY • PINK - AS SSORS COPY „
B
-15.61n
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CITY OF NORTHAMPTON
MASSACHUSETTS
OFFICE of the INSPECTOR of BUILDINGS
- e n
`<_- Page3 Plot / � APPLICATION FOR
ZONING PERMIT AND
INSPECTOR BUILDING PERMIT
IMPORTANT - Applicant to complete all items in sections: I, II, III, IV, and IX. o
Al iLOGFTIONI lig ', . ZONING SIR
/
DISTRICT
LOCATION IND.1 IS
OF BETWEEN AND
BUILDING IcRose sTNee„ ICROss sre4ETI
LOT
SUBDIVISION LOT BLOCK SIZE —
en
II. TYPE AND COST OF BUILDING - A/I applicants complete Ports A - D -a
Po
A. TYPE OF IMPROVEMENT D. PROPOSED USE — For"wrecking' most recent use m
m
I 'NNew building g Rezidamiol Nonresidential
21 ] Addition(If residential, enter number12 One family IB ❑ Amusement, recreational
of feu
bo stnR UnllIS added, if any,
in Pam D, 1.3) 13 Two or more family — Enter 19 Li Church, other religious
3 [ Alteration rtes 2 above) numberohmits-- — y 20 Industrial
14 ❑ Transient hotel, motel, 21 � Parking
4I I Repair, replacement or dormitory — Enter number garage
5I J Wrecking (If multifamily r siders al, f units y 22I I Service station, repair garage
enter
r brute nbe of as in building in 151 Garage 231 I Hospital, institutional
Part D, 191
6 ] Moving (relocation) 16I I Carport 24 r I Office, bank, professional
T Foundation only 17 Li Other — Specify 25❑ Public utility
�/{�/1 �9�(q(J��'�� 26 ❑ School, library, other educational
B. OWNERSHIP �'8 27❑ Stores, towersmercantile��[J� Q 20 LI Tanks,
6l. Private(individual, torpor awes
nonprofitc.)at 2911 OmerSpecify
9 Public (Federal,tState, or
local government)
C. COST (Omit cents) Nonresidential — Describe in detail proposed use of buildings, e.g., food
/J—��.�
processing plant, machine shop, laundrybuilding
s
building at hospital, elementary
10. Cost of improvement $ V4+0school, secondary school, college, parochial school, parking garagefor
departmentrental office building, office building atindustrial plant.
To he F_ztalled hut not included If usof xisting bulding is being changed, enter propoed use.
in the above cast
a. Electrical
b. Plumbing
c. Heating, air conditioning
d.Other (elevator, etc)
11. TOTAL COST OF IMPROVEMENT $ CO V
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 in Masonry Hall bearing) Public o private company48. Number of stories
31 Wood frame 41 Private (septic .rank, a c 49. Total square feet of floor � 'V` 14
32 iI Structural steel all fldimensions oba ed on exterior
33 i''' Reinforced concrete H. TYPE OF WATER SUPPLY
34❑ Other — Specify 42 Public or private company 50. Total land area, sq. ft
431_ Private Hell, cistern) K. NUMBER OF OFF.STREET
PARKING SPACES
F. PRINCIPAL TYPE OF HEATING FUEL I. PE OF MECHANICAL sl. Enclosed
35 I Gas Will me be central air 52. Outdoors
361 ] Oil condition ..o
L. RESIDENTIAL BUILDINGS ONLY
37 _Electricity 44 1 Yes r5 No 53. Number of bedrooms
38 L. Coal
391 ' Other — Spec'fy Will there . an e.evo•or { Full
54. Number of
46 L.I Yes 47 _ No bathrooms
Pan al
IV. IDENTIFICATION - To be completed by all applicants
Name Malting address - Ayrrahrr. r -
street. rn>, and State ZIP code Tel. No.
I
'1 r (I ity //'$/� P/CQbO
L.esseeor ]2 Dv.--
e,n Ider s
'Contractor _ Lmee.e No.
CU �
3.
Architect or
Engineer
I hereby certify that the proposed work is authorized by the owner of record and that I hove been authorized by the owner to
make this application as his authorized agent and we agree to conform to all applicable lows of this jurisdiction.
Signor of applicant 4/ Address Application date
ln 00 NOT WRITE BELOW THIS LINE
V. PLAN REVIEW RECORD — For office use
Plan
Plans Review Required Check FReview Dote Started ns By Dote Plans
Approved
By Notes
ppr P
BUILDING $
PLUMBING $
L__
MECHANICAL $ __
ELECTRICAL $ _
OTHER $
1
VI. ADDITIONAL PERMITS REQUIRED OR OTHER JURISDICTION APPROVALS
DaPermit or Approval Check Obtained
Number By Permit or Approval Check Oe bta inNumber 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. Use Group
Permit issued9,-4-11c2179j 19 �z.Building � Fire Grading
Permit Fee $ Lf O 0 Live Loading
Certificate of Occupancy $ /Py'S(�p¢/�fietee (� / Occupancy^ Load
Ise' d by: \ I /��j4�--M�tlX�
Drain Tile dL
Plan Review Fee $
TITLE
NOTES and Data — (For department use)
VIII. ZONING PLAN EXAMINERS�INNOTES
DISTRICT \ 12
USE V
FRONT YARD
SIDE YARD /("�4SIDE YARD 4,74)
—TJ
REAR YARD A ,r, j-O
NOTES �f/
IX. SITE OR PLOT PLAN - For Applicant Use
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BOCA FORM APflP - 669 01969 BUILDI NS Of rKi u. & CODE ADMINISTRATORS INTERNATIONAL, INC.