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NOTES and Data — (For department use)
IV. IDENTIFICATION — To be completed by all applicants
Name Mailing address — Number, street, city, and State ZIP code Tel. No.
�.
1. /tJ7/f /G /�/�Ef�i�rx�� /����hccrjiss
Owner or
Lessee
Bui Ider's
2.
License No.
Contractor �y
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 appli nt / - Ad ress Appl�i,ati n 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
Date Date
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 number1
Bul Iding• Use Group
Permit issued v�� 19
Building 0 ` d Fire Grading
Permit Fee $ ` �e d
Live Loading
Certificate of Occupancy $ Oacu ancy Load
pprov by:
Drain Tile $
Plan Review Fee $
TITLE
CITY OF NORTHAMPTON
�• MASSACHUSETTS
r
$ OFFICE of the INSPECTOR of BUILDINGS
Page Plot APPLICATION FOR
INSPECTOR ZONING PERMIT AND
BUILDING PERMIT
IMPORTANT — Applicant to complete all items in sections: 1, 11, 111, IV, and IX. /r O
ZING
• AT (LOCATION) / '�° ' "� �.�d�„ DIOSTR c/-
,
LOCATION (NO.) (STREET)
OF BETWEEN AND
BUILDING (CROSS STREET) (CROSS STREET)
LOT
SUBDIVISION LOT BLOCK SIZE
N
II. TYPE AND COST OF BUILDING — A11 applicants complete Parts A — D —1
A. TYPE OF IMPROVEMENT D. PROPOSED USE — For"Wrecking" most recent use M
M
1 ❑ New building Residential Nonresidential
2 Addition(lf residential, enter number 12 Q 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
3 ❑ Alteration (See 2 above) number of units— — — — --)� 20❑ Industrial
14 ❑ Transient hotel, motel, 21 ❑ Parking garage
4 Repair, replacement or dormitory — Enter number
5 ❑ Wrecking (1/multifamily residential, of units ——————— — -- 22 ❑ Service station, repair garage
enter number of units in building in 15 ❑ Garage 23❑ Hospital, institutional
Part D, 13) 16 ❑ Carport 24 E] Office, bank, professional
6 ❑ Moving (relocation)
7 ❑ Foundation only 17 ❑ Other — Specify 25❑ Public utility
Q 26 School, library, other educational
B. OWNERSHIP { �a r( �? rb r 27 ❑ Stores, mercantile
28❑ Tanks, towers
8 �Privote (individual, corporation, Specify
Other — S
nonprofit institution,etc.) / •"�' 29 ❑ p fy
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,,,,,,,,,•,,•,,, O 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 1$ 13-00
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 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?
_ N L. RESIDENTIAL BUILDINGS ONLY
37 Electricity fv.'i1 44 ❑ Yes 45o 53. Number of bedrooms..............
3B ❑ Coal / �/
39 ❑ Other — Specify Will there be an elevators Full..........
54. Number of
46 Yes 47 [C/No bathrooms
Partial......
I j---)-rtm,cr t of Bu,-10 Tr cC-tlu-r S
212 ' ,aln. Strect. BUILDING za el,
lo
0-q
PERMIT
29 - 22P VALIDATION
2r �qr
DATE I�ERMIT NO.
7 7-5 1,7
ADDRESS
APPLICANT ca (NO.) (STREET) (CONTR'S LICENSE)
PERMIT TO c2 t c,r o :o r cli On c 17 71�",".I Y NUMBER OF
(-) STORY DWELLING UNITS
(TYPE OF IMPROVEMENT) NO. (PROPOSED USE)
ZONING
AT (LOCATION) -16 I ','rive DISTRICT
(No.) (STREET)
BETWEEN AND
(CROSS STREET) (CROSS STREET)
LOT
SUBDIVISION LOT BLOCK SIZE
BUILDING IS TO BE 9 FT. WIDE By FT. LONG BY FT. IN HEIGHT AND SHALL CONFORM IN CONSTRUCTION
TO TYPE USE GROUP BASEMENT WALLS OR FOUNDATION (TYPE)
REMARKS: c r7a t to b- r clf, on- c w i('.'Q % 0 11 c C., a t tacb,eu
AREA OR PERMIT s
VOLUME 152 sq. ESTIMATED COST $ FEE
(CUBIC/SQUARE FEET)
OWNER BUIL
ADDRESS 16P By
WHITE - FILE COPY GREEN - FIELD COPY • CANARY - APPLICANT COPY PINK ASSESSORS COPY