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-, DEPARTMENT OF BUILDING INSPECTIONS
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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 A HOMEOWNER AND NOT A PROFESSIONAL CONTRACTOR IN NO WAY
ABSOLVES ME OF ANY RESPONSIBILITY TO INSURE THAT ALL fA-G TS
OF THE RULES AND REGULATIONS ARE COMPLIED WITH. �)
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SIDE YARD SIDE YARD
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NOTES and Data — (For department use)
Y t
IV. IDENTIFICATION — To be completed by all applicants
Name Mailing address — Number, stmt, city, and State ZIP code Tel. No.
Owner or _
Lessee
Builder's
2.
License No.
Contractor
3. `
Architect or
Engineer
4711t,y certi f f e propose work i s authori zed by the owner of record and that I have been authori zed by the owner to
his pli ati as i ulkorized agent and we agree to conform to all applicable laws of this jurisdiction.
re n /' Address j r Ppplicotion date
, 1 1 �� a —
fY�
00 NOT WRITE BELOW THIS LINE
V. PLAN REVIEW RECORD — For office use
Plans Review Required Check Plan Review Date Plans B Date Plans B Notes
4 Fee Started y Approved y
BUILDING $
PLUMBING $
MECHANICAL $
ELECTRICAL Is
OTHER Is
VI. ADDITIONAL PERMITS REQUIRED OR OTHER JURISDICTION APPROVALS
Permit or Approval Check Obttai
Date 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 (Aj Use Group
Permit issued 19
Building Fire Grading
Permit Fee $___ 1 �
�-7—r— Live Loading
Certificate of Occupancy $ Occupancy Load
Approved by:
Drain Tile $
Plan Review Fee $ R
TITLE
CITY OF NORTHAMPTON
�• •� MASSACHUSETTS
OFFICE of the INSPECTOR of BUILDINGS
Page— Plot APPLICATION FOR
INSPECTOR ZONING PERMIT AND
BUILDING PERMIT
z
IMPORTANT — Applicant to complete all items in sections: I, 11, 111, IV, and IX. O
ZONING
AT (LOCATION DISTRICT
LOCATION N0. (STREET) �4 S
OF BETWEEN EnLay_c AND CA.
OF
BUILDING (CROS STREET) (CROSS STREET)
LOT
SUBDIVISION LOT BLOCK SIZE
N
II. 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
1 New building Resi ntial 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 n Church, other religious
3 Alteration (See 2 above) number of units— — — — �. 20 n Industrial
14 D Transient hotel, motel, 21 C� Parking garage
4 Repair, replacement or dormitory — Enter number
5 �_ Wrecking (It multifamily residential, of units ——————— — --� 22 Service station, repair garage
enter number of units in building in 15 L] Garage 23 Hospital, institutional
Part D, 13)
16 Carport 24 Office, bank, professional
6 Moving (relocation)
7 Foundation only 17 Other — Specify 25 Public utility
26 School, library, other educational
B. OWN RSHIP 27 Stores, mercantile
8Private (individual, corporation, 28 ❑ Tanks, towers
nonprofit institution, etc.) 29 Other — Specify
9 D 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....................... r y
b. Plumbing .....................
c. Heating, air conditioning..........
d. Other (elevator, etc.).............
11. TOTAL COST OF IMPROVEMENT $ (00 `li%'
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
31 `Wood frame 41 n Private (septic tank, etc.) 49. Total square feet floor area,
all floors, based on n 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 7 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........................
conditioning?
36 � Oil L.�RESIDENTIAL BUILDINGS ONLY
37 j Electricity 44 Yes 45 No f�
53. Number of bedrooms..............
38 Coal
39 n Other — .Specify Will there be an elevotor� Full..........
54. Number of
-iii I
46 Yes 47 4N0 bothrooms
Partial.......
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