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NOTE:IN ORDER THAT THIS APPLICATION MAY BE ACCEPTED,THE DATA CALLED FOR BELOW MUST BE SO SET FORTH THAT
WE CAN DETERMINE FROM THE APPLICATION AND THE ACCOMPANYING PLANS WHAT THE EXISTING CONDITIONS ARE AND
WHAT THE FUTURE CONDITIONS WILL BE.
Plans,in duplicate,mustbe filed with this application before a permit will be granted,one of which,upon issuance
of the permit shall be kept at the site during the progress of the work.
New...............❑
Addition........❑
No.................—D, Zone..................., Type..................., Map..... Parcel....1.�....... Alterations ....V
ate Repair............❑
I
CITY OF NORTHAMPTON Demolition....❑
e MASSACHUSETTS
Application for other than a Dwelling Permit
(To be filled out in ink OR on a typewriter)
To the Building Inspector: Date............. �............... 19
Application for a permit is hereby made according to the following:-
1. Location, Street and NIP,......../......1r' ,...Se ......................................................................................
2. Nearest cross street A"4.-C..It..�
.... ... / ...................................::...:�.................. Lot No....................
3. Owner's name... 9 9 ... 7. �z.OGL°................................. Address f ..... ... �C...l
4. Architect's name......... ........................................................ ........
....... Address ....... ... ....
t:lC 5. Builder's name � �'. ... Address 110f...../?e-krA.. ... dles�ce
/ .
6. Use of building, Present...0. . ................ Proposed ... .. ..........
n how man Str ts�
7. Building fronts o y .......1.�'I:L�............................. ...................................................................
8. Is building in fire district?................f IF ...........................................................................:.................................
9. Size of building,Width in ft. ..........3.Q.............. Length in ft..11................, Height to ft........
10. Distance of building from Street Line................ left lot line..........., right lot line..........., rear lot line...........
11. Type of construction(check one): 1—A.......... 1—B .......... 1—C .......... II.......... III.......... IV.......... V ..........
Stories B 1 2 3 4 5 6 7 Roof
Story heights in ft. 8
Thickn's of walls in ins. It
Material of walls 3w
W cL^b
Material of floor/roof _
S t.x17
Design live load C)
Design dead load 1C)
Occupancy or Use R s
No.of persons/families
No.of stairs
12. Soil under footing is........LIA................................................................................................................................
13. Depth of footing below grade.....N/A....................p. ft. Will piles be used?...................................
14. Area of entire building(Present plus new) .........A.. ..P........................................................................... sq.ft.
15. Type of roof--flat....................... pitched............✓......... Material of roof covering....... ..........................
16. No.of elevators N.W IF_ Method of heating/�.d'.l!... System ................................. Fuel .................................
17. Are live loads noted on drawings? ..N ..... Are all other structural conditions noted on drawings?....Nb........
18. Building(will be)(is)equipped with sprinklers?.... ..................With sprinkler alarm?.....Y.S.............
19. Is building to be used as a factory,workshop or mercantile or other establishment employing 10 or more persons?
&u............................................................................................................................................................
20. Is building to be used as an office building,dormitory,hotel,family hotel,apartment or boarding house,lodging
house or tenement house having 8 or more rooms above the second story? .....N.Q............................................
21. How many exits(per floor)to street? 4
................ ....................................................................................................
22. Is building a"Place of assembly"as defined by the General Laws? ......N.-�)........................................................
23. Will building conform to the General Laws? ..../r5............. Building and Zoning Ordinances?.i� .. ...........
24. If a garage,distance from nearest building? ......Y.41. .......................................................................................
25. If an addition,alteration or demolition,when was building erected?......../.t�i...7.` Y..............................................
26. Estimated costs:— The undersigned certifies that the above statements are true to the best
General$......M.,.. ................ of his r knowledge an belief.
Plumbing..........�1..:.. ! .. ........... i • ......
l........... ... . ..
Gas Piping sign ure of owner,architect or engineer
................
Sprinklers....... ..�............ WRITTEN DISCRIPTION OF WORK TO BE DONE
...
Heating ,.. (Use blank half of reverse side,if necessary)
.�. cam..`........... u�:.. <
rJ
... ...............
Electric............ ..........................
Other ,.: . .. ""C.,�.�.a:.......................................................................
Total$A.......1.�. ./...M,.............. ...............................................................................................................
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