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NOTES and Data — (For department use)
IV. IDENTIFICATION — To be completed by all applicants
Name Mailing address — dumber, street, city, and State ZIP code Tel. No.
1. H
Owner or
Lessee J
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
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
D Date
Permit or Approval Check ObObtained ned 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 190—�--
Building Fire Grading
Permit Fee $ f' Live Loading
Certificate of Occupancy $ Occ n y Load
Approved
Drain Tile $
Plan Review Fee $
TITLE
•
` s CITY OF NORTHAMPTON
.� MASSACHUSETTS
) i
OFFICE of the INSPECTOR of BUILDINGS
A
Page Plot 9 APPLICATION FOR
INSPECTOR ZONING PERMIT AND
BUILDING PERMIT
z
IMPORTANT — Applicant to complete all items in sections: 1, 11, 111, IV, and IX. O
ZONING
I• AT (LOCATION) a /• DISTRICT
LOCATION (NO.) (STREET) j/J
OF BETWEEN X.. !'c�JAC 0—/P- AND &/,pp r'"1/S.G'(/'!l .. i
BUILDING (CROSS STREET) (CROSS STREET)
LOT
SUBDIVISION LOT BLOCK SIZE
N
11. TYPE AND COST OF BUILDING — All applicants complete Parts A — D A
A. TYPE OF IMPROVEMENT D. PROPOSED USE — For"Wrecking" most recent use m
M
—1
1 ❑ New building Re i ntial Nonresidential
2 --1i Addition(If residential, enter number of new housing units added, if any, 12 One family 18 Amusement, recreational
in Part D, 13) 13 Two or more family — Enter 19 Church, other religious
3 Alteration (See 2 above) number of units— — — — �. 20 Industrial
14 Transient hotel, motel, 21 l Parking garage
4 Repair, replacement or dormitory — Enter number
5 ❑ Wrecking (If multifamily residential, of units ——————— — --ta 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 C Moving (relocation)
17 Other — Specify 25 �� Public utility
7 Foundation only
26 School, library, other educational
B. OWNERSHIP 27 Stores, mercantile
8 Private (individual, corporation, 28 n 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„•„•.,,,•„•„ 1— school, secondary school, college, parochial school, parking garage for.
deportment store, rental office building, office building of 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..................... , `9
b. Plumbing .....................
c. Heating, air conditioning.........i.
d. Other (elevator, etc.).............
11. TOTAL COST OF IMPROVEMENT $ .
ill. SELECTED CHARACTERISTICS OF BUILDING — For new buildings and additions, complete Parts F — 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 ) �7 48. Number of stories................
y (wall bearing) 40 Public or private company
31 Wood frame 41 n 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 ores, sq. ft. ..........
43 �` Private (well, cistern) K. NUMBER OF OFF-STREET
PARKING SPACES
F. PRINCIPAL TYPE OF HEATING FUEL 1. TYPE OF MECHANICAL 51. Enclosed ......................
35 Gas Will there be central air 52. Outdoors........................
36 Oil conditioning?
_ L. RESIDENTIAL BUILDINGS ONLY
37E__1 Electricity 44 F7 Yes 45 !_7 No 53. Number of bedrooms.............
38 Cool
39 n Other — Specify Will there be an elevators m Full.........
�� 54. Number of
46 F] Yes 47 L_J No bathrooms
Partial.......
.._ .. .._. _.,, o, ..
� � •V£i� r� rv4w ��
i
a DEPT. OF BUILDING INSPECTIONS BUILDING �x)
212 Main Street 00 J
` Northampton, MA 01060 PERMIT
29XX - 295 OCT. VALIDATION
DATE XIMI l4 J'e 19 PE ITN 643
APPLICANT Ronald G. Vervi I Ie ADDRE5S 27 n - , �'oreR r
(NO.) (STREET) (CONTR'S LICENSE)
PERMIT TO Addition STORY One Family DWELLING UNITS
(TYPE OF IMPROVEMENT) NO. (PROPOSED USE)
AT (LOCATION) 27 Pencasal Dr. Florence ZONING
DISTRIC
(NO.) (STREET)
BETWEEN AND
(CROSS STREET) (CROSS STREET)
LOT
SUBDIVISION LOT BLOCK SIZE
BUILDING IS TO BE FT. WIDE BY FT. LONG BY FT. IN HEIGHT AND SMALL CONFORM IN CONSTRUCTION
TO TYPE USE GROUP BASEMENT WALLS OR FOUNDATION
(TYPE)
REMARKS. permit for the addition of a 12' X 5' porch (side)
AREA OR 60 sQ. f t. ESTIMATED COST 500.00 F
LUME EE$ 10.00
VO
(CUBIC/SQUARE FEET)
OWNER Same as Applicant
ADDRESS Same as Applicant's eY "
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