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NOTES and Data — (For department use)
IV. IDENTIFICATION — To be completed by all applicants
Name Mailing address —(Number, stmt, city, and State }(ZIP code Tel. No.
Owner or 8 W / ld PO R LG� .. V10(00 �'
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 applicant Address Application date
00 NOT WRITE BELOW THIS LINE
V. PLAN REVIEW RECORD — For office use
Plans Review Required Check Plan Review Date Plans B Date Plans By Notes
4 Fee Started y Approved
BUILDING $
PLUMBING $
MECHANICAL $
ELECTRICAL $
OTHER $ T I
VI. ADDITIONAL PERMITS REQUIRED OR OTHER JURISDICTION APPROVALS
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
Building Use Group
Permit issued .( 19 "ok?
Building f c Fire Grading
Permit Fee $ L�� �`� Live Loading
Certificate of Occupancy $ Occupancy d
App ved A
Drain Tile $
Plan Review Fee $
TITLE
*400 CITY OF NORTHA]KPTON
�. MASSACHUSETTS
r •
$ 6 OFFICE of the INSPECTOR of BUILDINGS
Page Plot_ 17 APPLICATION FOR
ZONING PERMIT AND
INSPECTOR BUILDING PERMIT
z
IMPORTANT — Applicant to complete all items in sections: 1, 11, III, IV, and IX. 0
ZONING
f/_�/.JR DISTRICT,��
I• AT (LOCATION)
LOCATION (NO.) (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
M
A. TYPE OF IMPROVEMENT D. PROPOSED USE — For"Wrecking" most recent use m
1 ❑ New building Residential Nonresidential
2 ❑ Addition((/ 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— — -- — -i 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 (11 multi family residential,
of units -------- — --� 22 Service station, repair garage
enter number of units in building in 15 El Garage 23 Hospital, institutional
Part D, 13) 16❑ Carport 24 E] Office, bank, professional
6 ❑ Moving (relocation) 17❑ Other — Specify
25 Public utility
7 ❑ Foundation only 15-L-6 i ! 26 ❑ School, library, other educational
B. OWNERSHIP 27 ❑ Stores, mercantile
28 ❑ Tanks, towers
8 [XPrivate (individual, corporation, I,w
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 existing building is being changed, enter proposed use.
in the above cost
a. Electrical.....................
b. Plumbing .....................
c. Heating, air conditioning..........
d. Other (elevator, etc.).............
11. TOTAL COST OF IMPROVEMENT $ 40 Q
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
48. Number of stories...............
30❑ Masonry (wall bearing) 40 ❑ Public or private company
Private (septic tank, etc.) 49. Total square feet of floor area,
41
31 ❑ Wood frame p 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 .......................
F. PRINCIPAL TYPE OF HEATING FUEL I. TYPE OF MECHANICAL
35 Gas Will there be central air 52. Outdoors........................
36 ❑ Oil conditioning? L. RESIDENTIAL BUILDINGS ONLY
37 C Electricity 44 —] Yes 45 �ll No 53. Number of bedrooms..............
38 ❑ Coal
39 Other — Specify Will there be an elevator? 54. Number of Full..........
bathrooms
46 �❑ Yes 47 No Partial........
416
Depart .ent 0{ ')din Insr}cr.tions
212 Pain s
Nartha: ptan, `Xi.ass. , 01060 BUILDING o-°
PERMIT �a
29 - 297
VALIDATION
i
DATE July 11, 19_—P'' PERMIT NO. 33?
APPLICANT :=i , ari' ?C rt L7 : ADDRESS cl� Brookside Circle N/A
(NO.) (STREET) (CONTR'S LICENSE)
PERMIT TO Ibbo c Pool STORY One Fa- i 1 NUMBER OF
(_) _
(TYPE OF IMPROVEMENT) NO. (PROPOSED USE) DWELLING UNITS
Brook,—He Circle ZONING
AT (LOCATION) DISTRICT
(NO.) (STREET)
BETWEEN AND_
(CROSS STREET) (CROSS STREET)
LOT
SUBDIVISION LOT BLOCK_ SIZE
BUILDING IS TO BE 1J FT. WIDE BY 'I FT. LONG BY FT. IN HEIGHT AND SHALL CONFORM IN CONSTRUCTION
TO TYPE USE GROUP BASEMENT WALLS OR FOUNDATION
(TYPE)
perarit for a above �rour_d pool
REMARKS:
AREA OR VOLUME ESTIMATED COST $_ 1(00,.00 PERMIT 9u
(CUBIC/SQUARE FEET)
OWNER Bei-crly Andre?aS
ADDRESS 1,20 73roolc,szde. Circle g
WHITE — FILE COPY . GREEN - FIELD COPY ■ CANARY - APPLICANT COPY PINK - ASSESSORS COPY