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I MO vo r vvoZ dz NOTE:IN ORDER THAT THIS APPLICATION MAY BE ACCEPTED,THE DATA CALLED FOR BELOW MUST BE SO SET FORTH THAT WE CAN DETERMINE FROM THE APPLICATION AND THE ACCOMPANYING PLANS WHAT THE EXISTING CONDI- TIONS ARE AND WHAT THE FUTURE CONDITIONS WILL BE. Plot Plans and Plans,must be filed with this application before a permit be granted. Zone APPLICANT NOT TO FILL IN SPACES ABOVE THIS LINE Application for a Dwelling Permit a Northampton,Mass. . . . . . . . . . . . . . . . . . . . . . . . 19 . . . . . Telephone No. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 7b the Supt. of Buildings: Application for a permit to build is hereby made according to the following:- 1. Location, Street and No. . ./.(it . . /U • C.vR C.L&. . . • /• .L P t L.(EIV(,.6 . • • . • • • Lot No. . . .7`] 2. Nearest cross street . . C ✓L�2 .lj.r���.4 . .��. • . . . . Size of lot . . .I/��0..�.O• •P P.L.U.S. . . . . . • . . • • . • . 3. Owner's name -/ 11.x.r2.1.q N. .qj IZ. . . . fz!CL I !L . . . . . . Address .f.f�. • ,-t.v.S 77.tA.,. C.I:2 C.L 4E. ./-4o!z 4. Architect's name. . . . . . . . . . . . . . . . . . ... . . . . . . . . . .. . . . . . . . . Address . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 5. Builder's name . . . . . . . . . . . . . . . . Address J2.�4-0A'tz(.. . .�./ Mass.Construction Supervisor's License No. . .C)0 Q.A (o. . . . . . .. . . . . Expiration Date . . . 3 4• •� S3• • • • . . • • 6. Use of Building:One-family . . . . . . . . . . . . . . . . . . . . Two-family . . . . . . . . . . . . . . . . . . . . Other . . . .f. 4,1.G.d. . . . . 7. Number of rooms in each family ,A�unit: . . . . . . . . . . . . . . . . . . . . . . . Number of Bathrooms . . . . . . . . . . . . . . . . . . . . . . . 8. Is there a garage attached? . . / o. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .. . . . . . . . . .. . . . . . . . . . . . . . . . 9. Size of building . . . .p N. A .1.4. . . . . . . . . . . . . . . . . . . . . . Square footage FT,. . . . . . . . . . . . 10. Number of stories . . . . .(. .. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .. . . . . . . . . . . . . . . . . . . . .. . . . . . . . . . . . . . . . . . . . . . . . . . i 11. Distance from finished grade to high point of roof y. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 12. Type of construction . . .,57-1C. ry . . .(.F2 N. 9. . . . .W.1.T 0 . . . . .r v.SS. . . ko aI,=. . . . . . . . . . . . . . . . . . . . 13. Distance from building to street line in feet . . . . . .�.W.I. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .. . . . . . . . . . . . . . . . 14. Distance from building to side lot lines in feet:Left . . .9.N� .1. . . . . . . . . . . . . . . Right . . . ./. .y,.1 . . . . . . . . . . . . . . 15. Distance from building to rear lot line in feet . . . .. . .1.2).1. . . . . . . . . . . . . . . . . . . . . . . .. . . . . . . . . . . . . . . . . . . . . . . . . . 16. Is a plot plan being filed with this application? . . ../K S . . . . . . . . . . . . . .. . . . . . . . . . . . . . . . . . . . .. . . . . . . . . . . . . . . . 17. Species of framing lumber:DF . . . . . . . . . . . . . . . . . . . . Spruce . . . . . . . .. . . .. . . . . . Other . . . . . . . . . . . . . . . . . . . . 18. Are all structural conditions noted on drawings? . . . .�!rt'.S. .. . . . . . . . . • . • . . • • 19. Nature of land upon which the structure will be erected:Natural . . X. . . . . . . . . . . . . . . Filled . . . . . . . . . . . . .. . . . . . 20. Depth of basement or cellar floor below finished grade . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .. . . . . . . . . . . . . . . . ii 21. Material of foundation walls . . .C.4!-. 12.K'p e. . . . . . . . . . . . . . • • • • . . . Thickness in inches . . . . . . . . . . . . . . . . . . 22. Type of roof:Flat . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ... . . . . . . Pitched . . ..5 . . . . . . . . . . . . . . . . . . . . . . . .. . . . . . 23. Material or roof covering . . /13 PRA 5H .. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 24. Method of heating . . . . . . . . . . . . . . . . .. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 25. Will the building conform to the Building and Zoning Ordinances? . .vk S . . . . . . . . . . . . . . I . . . . . . . . . . . . . . . I . . . . . 26. Septic Tank? . . .P..1+. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . City Sewer? . N a. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 27. Construction within 100 ft.of wetlands? . . .A-)d. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 28. Construction within 100 year flood plain? . ./o. . . . . . . . . . . . . . • • . 29. Estimated cost:Total $ . . . . . i. 5-4 No building or structure which is erected or altered,shall be used,in whole or in part,for any purpose until a certificate of occupancy is issued by the Building Inspector. The undersigned certifies that the above statements are true to the best of his knowledge and belief. . . . . . . . . . . . . . . . . . . .. . . . . . . . . . . . . . . . . . . . . . . . . . . ignature of Contractor Signature of responsible applicant WRITTEN DESCRIPTION OF WORK TO BE DONE . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .. . . . . . . . . .. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .. . . . . . . . . . . . . . . . . . . .. . . . . . . PERMIT APPLIGAI WN LHECK L181 PAGE PLOT `%'I'( ZONE ( '� - r , y 4 YES NO DATE _ 1( 1 . ZONING FORM APPLICATION 2 . PERMIT APPLICATION 3 OWNER OCCUPANT STATEMENT / LIC # IF NOT 4 . 3 SETS OF NS - /PLOT PLAN 5 . NEW CONSTRUCTION 6 . CURB CUT 7 WATER V L I IT FORMS 8 . REMODELTNG REMODELING INTERIOR 9 . ADDITI 10 . ACCESSORY STRUCTURE 11 . SIGN AWNING 2 , PERMIT FEE - CHECK ONLY - O E O DERV 13 . SPECIAL PERMIT REQUIRED WITH DEED IF APPLICABLE 14 . UNDER SECTION 127 - CMR 780 15 . FORM 16 , FILL 1 I N T S �7• i Or .pq9 .((, `` v s W w •nu,.,u��..`•. 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