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NOTES and Data — (For department use)
IV. IDENTIFICATION — To be completed by all applicants
Name Mailing address — \'umber, street, city, and State ZIP code Tel. No.
O wner or v 2 &"t5- a 1 Q60 ^y
� —
Lessee
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.
Signature of applicanntf Addrfess Application date
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 $
VI. ADDITIONAL PERMITS REQUIRED OR OTHER JURISDICTION APPROVALS
ate Date
Permit or Approval Check ObDtai ed 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
Building 11 Use Group
Permit issued d 19
Building Fire Grading
Permit Fee $ X.2
Live Loading
Certificate of Occupancy $ Occupancy Load
Approved by:
Drain Tile $
Plan Review Fee $
c
TITL
CITY OF NORTHAMPTON
�• .� MASSACHUSETTS
• a
OFFICE of the INSPECTOR of BUILDINGS
Page 27 Plot '/77 APPLICATION FOR
INSPECTOR
ZONING PERMIT AND
BUILDING PERMIT
z
IMPO — licant to complete all items in sections: 1, 11, 111, IV, and IX. O
�g ZONING
I• AT (LOCATIO ), DISTRICT
LOCATION sT REET)
OF BETWEEN AND
BUILDING (CROSS STREET) (CROSS STREET)
LOT
SUBDIVISION LOT BLOCK SIZE
V1
11. 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
I V New building Residential Nonresidential
2 ❑ Addition(If residential, enter number 12 One family 18❑ Amusement, recreational
of new housing units added, if any,
in Part D, 13) 13 ❑ Two or more family — Enter 19 ❑� Church, other religious
number of units— — — — 20 Industrial
3 ❑ Alteration (See 2 above)
14 ❑ Transient hotel, motel, 21 C� Parking garage
4 ❑ Repair, replacement or dormitory — Enter number 22 Service station, repair garage
5 ❑ Wrecking (11 multifamily residential, of units ——————— — —�
enter number of units in building in 15 ❑ Garage 23 ❑� Hospital, institutional
Part D, 13) ❑
16 Carport 24❑ Office, bank, professional
6 ❑ Moving (relocation)
�y 26 17 ❑ Other — Speci/y 25 Public utility
Y
Y—�0`C
7 I XI Foundation only ❑
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 xi sting building is being changed, enter proposed use.
in the above cost
a. Electrical..................... A
f
b. Plumbing ......................
c. Heating, air conditioning..........
d. Other (elevator, etc.).............
11. TOTAL COST OF IMPROVEMENT is
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 area, sq. ft. ..........
43 ❑ Private (well, cistern) K. NUMBER OF OFF-STREET
PARKING SPACES
F. PRINCIPAL TYPE OF HEATING FUEL I. TYPE OF MECHANICAL 51. Enclosed .......................
35 ❑ Gas Will there be central air 52. Outdoors........................
36 ❑ Oil conditioning? L. RESIDENTIAL BUILDINGS ONLY
37 Electricity 44 ❑ Y es 45 iii No
_ 53. Number of bedrooms..............
38 ❑� Coal
39 ❑_ Other — Specify Will there be an elevator? Full..........
54. Number of
46 1 Yes 47 'D No bathrooms
Partial......
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