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No. Owner or Lessee � •1� r rr� Bui Ider's 2 / .r' 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-.pf 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 Q Fee Started y Approved y BUILDING $ PLUMBING $ MECHANICAL $ ELECTRICAL $ OTHER $ VI. ADDITIONAL PERMITS REQUIRED OR OTHER JURISDICTION APPROVALS Permit or Approval Check Obtained Number By Permit or Approval Check ObtDa t ed 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 Building- Use Group Permit issued L /42Z � 19 _ Building Fire Grading Permit Fee $ Live Loading Certificate of Occupancy $ Occupancy Load Approved by: Drain Tile $ ��y� _ . n/� g!1� Plan Review Fee $ TITLE " CITY OF NORTHAMPTON $+ MASSACHUSETTS $ OFFICE of the INSPECTOR of BUILDINGS wt Page_ Plot APPLICATION FOR INSPECTOR 1 ZONING PERMIT AND BUILDING PERMIT IMPORTANT — Applicant to complete all items in sections: 1, 11, 111, IV, and IX. O I• - AT (LOCATION) '�� 'C �_ CU 1.22c DISTRICT CT LOCATION (NO.) (STREET) OF BETWEEN AND BUILDING (CROSS STREET) (CROSS STREET) LOT SUBDIVISION LOT BLOCK SIZE N 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 2 f�q 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 number of units— — — — -� 20❑ Industrial 3 ❑ Alteration (See 2 above) 14 ransent hotel, motel, ❑ T i h tl 21 ❑ Parking garage 4 ❑ Repair, replacement or dormitory - Enter number 5 ❑ Wrecking (If multifamily residential, of units ------- - � 22 ❑ Service station, repair garage enter number of units in building in 15 ❑ Garage 23 ❑ Hospital, institutional Part D, 13) 6 ❑ Moving (relocation) 16 ❑ Carport 24❑ Office, book, professional 17❑ Other - Specify 25❑ Public utility 7 ❑ Foundation only 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 s school, secondary school, college, parochial school, parking garage for, 10. Cost of improvement,,,,,,,,,,,,,,,, , - 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 pro sed us*. in the above cost a. Electrical..................... _ �, :-�✓ fit",--e_.-- �,,... � � _...,..._...-f b. Plumbing ..................... c. Heating, air conditioning......... d. Other(elevator, etc.)............ 11. TOTAL COST OF IMPROVEMENT yC 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 Ej4400d 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 ❑ Electricity 44 ❑ Yes 45 D No 53. Number of bedrooms.............. 38 ❑ Coal 39 ❑ Other - Specify Will there be an elevators Full.......... 54. Number of 46 ❑ Yes 47 ❑ No bathrooms Partial........ S i i, w e DEPT. OF BUILDING INSPECTIONS BUILDING z ! 212 Main Street Da Northampton, MA 01060 PERMIT 29 - 377 VALIDATION 7 DATE September 20 19 85 �PE T J�O. 5- 2 - APPLICANT Kathleen Santos ADDRESS D brookwoocl rive Owner IND.) (STREET) (CQNTR'S LICENSE) PERMIT TO Addition One Family NUMBER OF STORY DWELL NG UNITS (_) (TYPE OF IMPROVEMENT) NO. (PROPOSED USE) 5 Brookwood Drive 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 to construct a masonary chimney AREA OR 200.00 PERMIT $ 10.00 VOLUME ESTIMATED COST FEE (CUBIC/SQUARE FEET) OWNER Mannuel & Kathleen Santos r)o o Drive BUILDING ADORESS BY WHITE - FILE COPY . GREEN - FIELD COPY • CANARY - APPLICANT COPY • PINK - ASSESSORS COPY p111SNP