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DEPARTMENT OF BUILDING INSPECTIONS ` te� ) INSPECTOR 212 Main Street ' Municipal Building `` Northampton, Mass. 01060 ` AS A HOMEOWNER I UNDERSTAND THAT I MAY APPLY FOR AND RECEIVE A BUILDING PERMIT FOR A HOME OR ADDITION I INTEND TO LIVE IN. I ALSO UNDERSTAND THAT I AM RESPONSIBLE FOR KNOWING THE STATE BUILDING CODE AND ZONING ORDINANCE OF THE CITY OF NORTHAMPTON. BEING AHOMEOWNER AND NOT A PROFESSIONAL CONTRACTOR IN NO WAY • ABSOLVES ME OF ANY RESPONSIBILITY TO INSURE THAT ALL FACETS OF THE RULES AND REGULATIONS ARE COMPLIED WITH. • •. . "07-----V .,.. #60 7 7 . • r " ro = 1 c- c b —• r� z �Nw.ve.;peso• Cl) 0,1::: _r' �, �' �. '< ^' ° ¢ -I 4 s-...\-�is.At v- H C �� y 7 •z ° 01 , c= tt °° ' ° _ °° ° r re at tist O C h r9 c z) -ft .Z C - p h C ,t C/) n �. .• C O rn,'y3 CI 0 0-- '0 ro et, L6 A4, (D r+y ' f rD a �...I << • < o W °• •0 -s 2C- 0 tmill4 (11116) `:i • r C rot.. a � B n *I*�cr O C ' = Z tilli:1°1 C, ` :1" � .= C C O 0.C a CD C '., • '+ d IZ• O g Z 7). r " C S • d 0 E. Ow 11111+" �+� 'CS =• l 1 CC e> .y V Q r o C v, O s.� e O'Q C. >j. = ° ^ C D CD Cep CIQ rD C Q _s Q d 0 ozi 5 (--) /lit • c 0 0 = = = = = = w Cr C a v a O D C° 'O ` `a `a `m. tt C� y C' =• C O O C C C t n M t:i . `� N y 4 ro R•T CD CA CA '1 , C �' a C' I W N M-■ ^ I I I 1 C o n bcA .4 p*11 o ro °• 0 ° O a b eD ° ` ,, til et) 11111111111i Po d tri 10 cep CM 0 o..../ �, =• C - n � �° rD cn y CA _� O CA �,z/^� = VI 4t1 9 0 IV. IDENTIFICATION — To be completed by all applicants • Name Mailing address — Number, stmt, city, and State ZIP code Tel. No. 1. Owner or •"o v,° 4". \.J u)1 c5-0 ©11 - t i 0l\4"ii o1 (�`(i'I�Y� L.i vlY Lessee KV d2 YYY /�1r7 - 'r•J" L� , i Mk Builder's 7 2. �A� �i `e* /o.4 }4.(122 M License No. Contractor '/ " ��''1� V r 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. Signature of a••licant Address Application date 404 i. � Q11e� � 1 DO 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 $ VI. ADDITIONAL PERMITS REQUIRED OR OTHER JURISDICTION APPROVALS Date Date Permit or Approval Check Obtained Number By Permit or Approval Check Obtained Number 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 lding C} Use Group Permit issued J't /1, 19 J Building , Fire Grading Permit Fee $ J6:-,, -676 Live Loading Certificate of Occupancy $ Occupancy Load Approved by: Drain Tile Plan Review Fee $ / /TITLE CITY OF NORTHAMPTON MASSACHUSETTS _�.J•n 'rl OFFICE of the INSPECTOR of BUILDINGS 30) Plot . APPLICATION FOR cro.),, Page � . INSPECTOR ZONING PERMIT AND BUILDING PERMIT z IMPORTANT — Applicant to complete all items in sections: 1, II, III, IV, and IX. 0 I. AT (LOCATION) �•i/ (�tiVf� � ZONING tjoie? DISTRICT I .fir LOCATION G, �(NO.) (STREET) j��j��� I4 OF BETWEEN w�lri�J 1�G AND 'V" (% o e hi, BUILDING (CROSS STREET) V (CROSS STREET) LOT SUBDIVISION LOT BLOCK SIZE V1 II. TYPE AND COST OF BUILDING — All applicants complete Parts A — D -I A. TYPE OF IMPROVEMENT D. PROPOSED USE - For"Wrecking" most recent use m m 1 I I New building Residential Nonresidential 2 I I Addition(// residential, enter number 12',One family 18I I Amusement, recreational of new housing units added, if any, in ['art D, 13) 13 Li Two or more family - Enter 19 Li Church, other religious number of units- - - - -- 20 r Industrial 3 Alteration (See 2 above) J 14 I j Transient hotel, motel, 21 L1 Parking garage 4 I I Repair, replacement or dormitory — Enter number 5 Li Wrecking (If multi family residential, of units - -2 22H Service station, repair garage enter number of units in building in 15 Li Garage 23 [1 Hospital, institutional Part D, l 16 Carport 24 11-1 Office, bank, professional 6 (_J Moving (relocation) 17 Li Other - Specify 25I _ I Public utility 7 [II Foundation only I 26 L [ School, library, other educational B. OWNERSHIP 27 f -i Stores, mercantile 8WPrivote (individual, corporation, 28 E] Tanks, towers nonprofit institution, etc.) 29 LI Other - Specify 9 Cii Public (Federal, State, or local government) C. COST (Omit cents) Nonresidential - Describe in detail proposed use of buildings, e.g., food 7 ��� 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 COC a. Electrical "1 if'✓ U4.1141' Kite/..(.1c a L.1_8 '. b. Plumbing oOC d ��Oltit..-k," (1 c. Heating, air conditioning d. Other (elevator, etc.) 11. TOTAL COST OF IMPROVEMENT $ /6J, 00 _ 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 Number of stories 31"Wood frame 41 Li Private (septic tank, etc.) 49. Total square feet of floor area, all floors, based on exterior 32 I Structural steel dimensions 33 L__I Reinforced concrete H. TYPE OF WATER SUPPLY 34 I_—_1 Other - Specify 42 Public or private company 50. Total land area, sq. ft. 43 I 1 Private (well, cistern) K. NUMBER OF OFF-STREET PARKING SPACES 51. Enclosed F. PRINCIPAL TYPE OF HEATING FUEL I. TYPE OF MECHANICAL 35Gos Will there be central air 52. Outdoors conditioning? 36 1_1 Oil L. RESIDENTIAL BUILDINGS ONLY 37 L i Electricity 44 L I Yes 45o 53. Number of bedrooms 38 Lzi Coal 39 ri Other - Specify Will there be an elevators Full 54. Number of 46 [ 1 Yes 47XNo bathrooms Partial