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NOTES and Data — (For deportment use)
l r �
� 1
IV, IDENTIFICATION — To be completed by all applicants
Nome Mailing address — Number, street, city, and State ZIP code Tel. No.
owner or o fi L L S
Lessee �LGCi' pr D O/06C�
Builder's
2, r, p�y pA/ License No. —�pf
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
t�
9
DO NOT WRITE BELOW THIS L NE
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 Permit or Approval Check Obtai ed Number By Permit or Approval Check obttaatned 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
II. VALIDATION
Building FOR DEPARTMENT USE ONLY
Permit number J
Building. Use Group
Permit issued _���� C� 1 19�
Building Fire Grading
Permit Fee $ t�A `W Live Loading
Certificate of Occupancy $ Occupancy Load
Approved by:
Drain Tile
Plan Review Fee $
TITLE
CITY OF NORTHAMPTON
g• g �.••, MASSACHUSETTS
q� f OFFICE of the INSPECTOR of BUILI)INGS
v 1YT Page Plot q5 APPLICATION FOR
1
INSPECTOR ZONING PERMIT AND
BUILDING PERMIT
z
IMPORTANT — Applicant to complete all items in sections: 1, 11, 111, IV, and IX. O
ZONING
• AT (LOCATION) P/,/V E°',� /�✓V c!L L S DISTRICT
LOCATION - (NO.) (STREET)
OF BETWEEN AND
BUILDING (CROSS STREET) (CROSS STREET)
LOT
SUBDIVISION LOT BLOCK SIZE
to
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 Residential Nonresidential
2F7 Addition(l/ residential, enter number
12� One family 18 ❑ Amusement, recreational
of new housing units added, if any,
Two or more family — Enter 19 Church, other religious
in Part D, 13) 13
number of units— — — — --)P. 20❑ Industrial
3 Alteration (See 2 above) 14 l
t
l
t
h
i
Transent hotel, motel,❑ 21 ❑ 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 ❑ Garage 23❑ Hospital, institutional
Part D, 13) ❑
16 Carport 24 Office, bank, professional
6 ❑ Moving (relocation)
7 ❑ Foundation only 17 F__1 Other — Speci/y 25� Public utility
26❑ School, library, other educational
B. OWNERSHIP 27❑ Stores, mercantile
8 Private (individual, corporation, 28❑ Tanks, towers
nonprofit institution, etc.) 29 ❑ Other — Specify
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•,,.,,,,•....... S 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 $ n OOv
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 of 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?
L. RESIDENTIAL BUILDINGS ONLY
37 Cl Electricity 44 Yes 45 No 53. Number of bedrooms..............
38 ❑ Coal
39 Other — Specify Will there be an elevator? 54. Nuinb Full..........
err of
46 ❑ Yes 47 W No bathrooms
-- Partial........
i a DiP BUILDING INSPECTIONS BUILDING �O
212 Main Street 'a `
Northampton, MA 01060 PERMIT
29 - 45 VALIDATION
GATE w 19 PERMIT NO.
APPLICANT Diggins & Worden September-0RES-SS 5y Conz-Street
(NO.) (STREET) (CONTR'S LICENSE)
PERMIT TO Alteration/Remodel(_) STORY One Family NUMBER of
DWELLING UNITS
(TYPE OF IMPROVEMENT) NO. (PROPOSED USE)
AT (LOCATION)
23 Pioneer Knolls ZONING URA
(NO.) (STREET) DISTRICT
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 is to remodel kitchen (existing) and install skylight
AREA OR VOLUME ESTIMATED COST $ 6.300.00 PERMIT
(CUBIC/SO DARE FEET) $ 28.00
OWNER Raymond F11Prhrnnk
ADDRESS 23 PionPPr Knolls, Nnrthamntnn ev(L �� „�„�---
WHITE - FILE COPY . GREEN - FIELD COPY ■ CANARY - APPLICANT COPY • PINK - ASSESSORS COPY PINT- P