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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
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
-G F
00 NOT WRITE BELOW THIS LINE
V. PLAN REVIEW RECORD — For office use
Plans Review Required Check Plan Fee Review Date Star Plans By Date Plans By Notes
BUILDING $
PLUMBING $
MECHANICAL $
ELECTRICAL $
OTHER $
VI. ADDITIONAL PERMITS REQUIRED OR OTHER JURISDICTION APPROVALS
Do te Permit or Approval Check Obtained Number By Per 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 Use (`croup
Permit issued
Building Fire Grading
Permit Fee $ � Live Loading
Certificate of Occupancy $ Occupancy Load
Approved by:
Drain Tile $ •
Plan Review Fee $
TITLE
CITY OF NORTHAMPTON
�• MASSACHUSETTS
$ e OFFICE of the INSPECTOR of BUILDINGS
�►
Page Plot cp�',•' APPLICATION FOR
INSPECTOR ZONING PERMIT AND
BUILDING PERMIT
IMPORTANT — Applicant to complete all items in sections: I, 11, 111, IV, and IX. C)
,. ZONING
i
I• AT (LOCATION) ' �'� < �` L i�c �� s `� t `1I`) �` DISTRICT
LOCATION (NO.) (STREET)
OF BETWEEN AND
BUILDING (CROSS STREET) (CROSS STREET)
LOT
SUBDIVISION LOT BLOCK SIZE
H
II. TYPE AND COST OF BUILDING — All applicants complete Parts A — D -4
A. T PE OF IMPROVEMENT D. PROPOSED USE - For"Wrecking" most recent use m
M
1 New building Residential Nonresidential
Addition(If residential, enter number 12 FI One family 18 Amusement, recreational
of new housing units added, if any,
in Part D, 13) 13 Two or more family - E?reteyf 19 Church, other religious
number of units- - - i 20 Industrial
3 Alteration (See 2 above) :`
14 Transient hotel, moth};' 21 Parkin
4 � Repair, replacement or dormitory - Efi1Pr number
C J g garage
o units ------- - --� 22 Service station, repair garage
5 Wrecking (U multifamily residential, / _
enter number of units zn building in 15 Garage 23 Hospital, institutional
Part D, 13) A
❑ 16 Carport 24 Office, bank, professional
6 Moving (relocation)
171 Other - Specify 25 Public utility
70 Foundation only
V7�\ 26 School, library, other educational
B. OWNERSHIP 4A 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 tail proposed use of buildings, e.g., food
processing plant, machine shop, I rndry building at hospital, elementary
10. Cost of improvement,,,,,,,,,,,,,,,, .`t schodr-TIecondary schoo I, col lege parochial school, parking garage for,
d artment store, rental office bull ing, office building at industrial plant.
To be installed but not included use of existing building is Ib g changed, enter proposed use.
in the above cost
a. Electrical.....................
X
b. Plumbing .......................
c. Heating, air conditioning..........
d. Other (elevator, etc.).............
11. TOTAL COST OF IMPROVEMENT $
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 Z,,Structurol 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
Yes 45 No 53. Number of bedrooms..............
37 Electricity 44
38 Coal
39 Other - Specify Will there be an elevator? Full..........
54. Number of
46 1 Yes 47 '2-J No bathrooms
Partial.......
DEPT. ,DING INSPECTIONS BUILDING 'z=
212 Main Street I O<IL i
Northampton, MA 01060 PERMIT
48 - 298 VALIDATION
DATE 19 ' MIT NQ- 244
APPLICANT David Braman ADDRESS 8 roo sl.de rir. f ore Owner
(NO.1 (STREET) (CONTR'S LICENSE)
Shed NUMBER OF
PERMIT TO New Building {`) STORY__ Storage DWELLING UNITS
ITYPE OF IMPROVEMENT) NO. (PROPOSED USET
AT (LOCATION) 128 Brookside Czr. ZONING Florence DISTRICT URA
IND.) (STREET)
BETWEEN AND
(CROSS STREET) (CROSS STREET)
LOT
SUBDIVISION LOT BLOCK SIZE
BUILDING IS TO BE 9 FT. WIDE BY 10 FT. LONG BY FT. IN HEIGHT AND SHALL CONFORM IN CONSTRUCTION
TO TYPE USE GROUP BASEMENT WALLS OR FOUNDATION
(TYPE)
REMARKS: permit for the construction of a new storage shed
AREA VOLUME 90 SCI. ft. ESTIMATED COST $ 300.00 FEEMIT 10.00
(CUBIC/SQUARE FEET)
OWNER Same ac App] i rent. A
8UILOING Ef �
ADDRESS Same f�C ATTnI i��nt'� BY„ (
WHITE - FILE COPY . GREEN - FIELD COPY ■ CANARY - APPLICANT COPY • PINK - ASSESSORS (OPY POP