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NOTES and Data — (For department use)
O gttMf p
�•� �� Crxf� of Norfilamptuit
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$ 9 �A56ACI�li8tff8 �
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O
DEPARTMENT OF BUILDIXG INSPECTIONS
INSPECTOR 212 Main Street ' Municipal Building
Northampton, Mass. 01060 V,
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 FACETS
OF THE RULES AND REGULATIONS ARE COMPLIED WITH.
IV. IDENTIFICATION — To be completed by all applicants
Name e� '7 Mailing address - Number, stmt, city, and State ZIP code Ter I. No.
1.
Owner or * s ` i sc/ 7 1S / 8 tj,0 , / / /Z� /ff� ~ l Y`�� �I�a tlJ� -Fil -Ji-A�i
Lessee C
Builder's
C 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
-""'c q
00 NOT WRITE BELOW THIS LINE
V. PLAN REVIEW RECORD — For office use
Plans Review Required Check Plan Review Date Plans B Date Plans
Fee Started y Approved BY Notes
BUILDING $
PLUMBING $
MECHANICAL $
ELECTRICAL
OTHER $
VI. ADDITIONAL PERMITS REQUIRED OR OTHER JURISDICTION APPROVALS
Permit or A roya l Check Date Dote
PP 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
Permit number 5-M FOR DEPARTMENT USE ONLY
Building
Use Group
Permit issued _ lq
Building Fire Grading
Permit Fee $ M
Live Loading
Certificate of Occupancy $ Occupancy Load
Approved by:
Drain Tile $ —�
Plan Review Fee $ _7 f
TLE
y CITY OF NORTHAMPTON
�. MASSACHUSETTS
$ e OFFICE of the INSPECTOR of BUILDINGS
Plot Page Plo ��
APPLICATION FOR
ZONING PERMIT AND
INSPECTOR BUILDING PERMIT
z
IMPORTANT — Applicant to complete all items in sections: I, II, 111, IV, and IX. C)
ZONING W
I• AT (LOCATION) f-?17 L R.r a L DISTRICT C_WJ
^
LOCATION (NO.) ! .-1 `STREET) '/
OF BETWEEN /1t`� ' U t AND 1L��0�
BUILDING (CROSS STREET) (CROSS STREET)
LOT
SUBDIVISION LOT BLOCK SIZE
F�
II. TYPE AND COST OF BUILDING — All applicants complete Parts A — D -0
M
A. TYPE OF IMPROVEMENT D. PROPOSED USE — For"Wrecking" most recent use M
—4
1 New building Residential Nonresidential
2 Addition((/ residential, enter number 12 One family 18 Amusement, recreational
of new housing units added, if any, 19 Church, other religious
in Part D, 13) 13 Two or more fomi ly — Enter ❑
number of units— — — — i 20 n Industrial a
3 Alteration (See 2 above) 14 Transient hotel, motel, �� y
21 Parking garage
4 Repair, replacement or dormitory — Enter number
22 L I Service station, repair garage
5 El Wrecking (If multifamily residential, of units ——————— — --� _
enter number of units in building in 15 Garage 23 L� Hospital, institutional
Part D, 13) 16 Carport 241—] Office, bank, professional C
6 L� Moving (relocation) 25(_� Public utility
17 � Other — SpeciJy
7 Foundation only 26 School, library, other educational �)
B. OWNERSHIP 27 Stores, mercantile
28 Tanks, towers
8 N Private (individual, corporation,
nonprofit institution, etc.) 29�� Other — Specify
9 L7 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,,,•,•.......... C�(?C? 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 fi
a. Electrical.....................
b. Plumbing .......................
c
c. Heating, air conditioning..........
d. Other (elevator, etc.).............
11. TOTAL COST OF IMPROVEMENT Is
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
41 Private (septic tank, etc.) 49. Total square feet of floor area,
31 Wood frame p all floors, based on exterior
32 Structural steel dimensions ...................
33 Reinforced concrete H. TYPE OF WATER SUPPLY
34 n Other — Specify 42 [y 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 LJ Gas Will there be central air 52. Outdoors........................
36 Oil conditioning? L. RESIDENTIAL BUILDINGS ONLY
37 Cf Electricity 44 ` ] Yes 45 X No 53. Number of bedrooms..............
38 Coal \
39 L Other — SpeciJy Will there be an elevotor° 54. Number of Full..........
bathrooms
46 � � Yes 47 '� No Partial........
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