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DISTRICT
FRONT YARD
SIDE YARD SIDE YARD
REAR YARD
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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.
Owner or
or
Lessee
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
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
9 Fee Started y Approved y
BUILDING $
PLUMBING $
MECHANICAL $
ELECTRICAL $
OTHER Is
VI. ADDITIONAL PERMITS REQUIRED OR OTHER JURISDICTION APPROVALS
Permit or Approval Check Obttaalned Number By Permit or Approval Check Date 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 �> _loas t 19
Building Fire Grading
Permit Fee $ (l`l`C Live Loading
Certificate of Occupancy $ Occupancy Load
Approved by:
Drain Tile $
Plan Review Fee $
ITLE
�- CITY OF NORTHAMPTON
9• "y.� MASSACHUSETTS
e 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, I1, 111, IV, and IX. O
�' / c ZONING .
• AT (LOCATION) C �' ✓� �`r ��l '� r' 1 el DISTRICT
LOCATION (NO.) (STREET)
OF BETWEEN AND
BUILDING CROSS STREET) ICROSS STREET)
LOT
SUBDIVISION LOT BLOCK SIZE
N
II. TYPE AND COST OF BUILDING — All applicants complete Parts A — D ;a
A. TYPE OF IMPROVEMENT D. PROPOSED USE — For"Wrecking" most recent use rn
rn
1 JSZLNew building Resid ntial Nonresidential
2 Addition(1 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 ❑� Church, other religious
3 Alteration (See 2 above)
number of units— — — — —� 20 f Industrial
❑
14 ❑ Transient hotel, motel, 21 [❑ Parking garage
4 ❑ Repair, replacement or dormitory — tel
number f
5 ❑ Wrecking (If multifamily residential, of units ——————— — --- 22 L_� Service station, repair garage
enter number of units in building in 15 C� Garage 23 Hospital, institutional
Part D, 13) ❑
16 Carport 24 ❑ Office, bank, professional
6 ❑ Moving (relocation)
17 C� Other — Specify 25 Public utility
7 ❑ Foundation only
26 E] School, library, other educational
B. OWNERSHIP 27 Stores, mercantile
8 Private (individual, corporation, 28 ❑ Tanks, towers
nonprofit institution, etc.) 29 ❑ Other — Specify
9 Ej Public (Federal, State, or
local government)
C. COST (Omit cents) Nonresidential — Describe in detail proposed use of buildings, e.g., food
1 processing plant, machine shop, laundry building at hospital, elementary
10. Cost of improvement,,,,••,•,.,...•. school, secondary school, college, parochial school, parking garage far,
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 I$
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 C_1 Public or private company 48. Number of stories................
31 Wood frame 41 F] Private (septic tank, etc.) 49. Total square feet of floor area, t
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
51. Enclosed .......................
F. PRINCIPAL TYPE OF HEATING FUEL I. TYPE OF MECHANICAL
35 ❑ Gas Will there be central air 52. Outdoors........................
36 ❑� Oil conditioning? L. RESIDENTIAL BUILDINGS ONLY
37 ❑— r
Electricity 44 ❑1 Yes 45 No 53. Number of bedrooms..............
38 ❑ Coal
39 C❑ Other — .Specify Will there be an elevatory 54. Number of Full..........
l
46 � Yes 47 �No bathrooms
Partial.......
6IPT':OF BUILDING INSPECTIONS BUILDING
212 Main Street O<
Northampton, MA 0t(1��0600 PERMIT
29 - {'i I VALIDATION
DATE 111 April 25' 1gQ o9 ERMIT Np15 } S
APPLICANT Kenneth & Donnalee Bou o ADDRESS v
IT rain ferr. r
(N0.) (STREET) (CONTR'S LICENSE)
storage Shed NUMBER OF
PERMIT TO New Building (_) STORY DWELLING UNITS
(TYPE OF IMPROVEMENT) NO. (PROPOSED USE)
68 Gilrain Terrace ZONING URA
AT (LOCATION) DISTRICT
(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 SHALL CONFORM IN CONSTRUCTION
TO TYPE USE GROUP BASEMENT WALLS OR FOUNDATION
(TYPE)
REMARKS: permit for the installation of a new 10' X 12' storage shed
AREA OR ¢�-I 1 ,400.00 PERMIT 10,00
VOLUME 1711 Q+ ft _ESTIMATED COST $ FEE
(CUBIC/SOUARE FEET)
s
OWNER Same as Applicants eUIL
ADDRESS Same a,, Abnl i ant) s BY
WHITE - FILE COPY . GREEN - FIELD COPY • CANARY - APPLICANT COPY • PINK ASSESSORS COPY pjNT P