29-416 (3) rya, For ALL buildings within Fire District and for other buildings costing$10,000.00 or more, plans
and specifications must be submitted to the Inspector of Buildings for examination and approval.
If building is to be moved give details relative to proposed location as for a new building.
c�?' Yl
Application for Permit to Build qR'A
Northampton, Mass., . ...... c..19 .... .
To the Inspector of Buildings:—
The undersigned hereby applies for a permit to build, move, alter, or repair, according to the
following specifications.-
1. Owner's name ....... .C...I. ......?..�.�. ...n. .....,. e.�.:..Y1..C ..S..,�. .............................................................................
2. Owner's address ._.._,::G..Z...... �_....L) i.......... .............. ..................
3. Architect's name .....................k.....1/.........................................................................._.....................................................................................
4. Builder's name ...........................................................................................................................................................................................
5. Builder's address ..........................................._.............................._..................................................................................................................
6. Location of Building. Street No. ...........lz_.(.........0J..?..P..).......VJ...Q... ... ....D..YE ..Q ..».�..�.....
7. Is this a removal or new building........................................_....................................................................................... .........................
8. If removal, from where .................................................................................................................................................................................
9. What is the purpose of building ...........CL....!=h......rx.:..Y:!... .. . ... .. ..a, ......�1 ...� .. ..:P......_.................
10. Material of building ........... .....i...... `A:.n.. ...r�.....�.J.a..C...L.5.................................................................
11. If a dwelling, for how many families ......................./.............._.....Number of rooms ....... ....................................
12. Is there to be a store in the building .....»...._.............A L.Q.................................._............._..:........................................................
13. Size of building, No. of feet front ........................:No. of feet deep ......................; No. of stories....................
14. Size of ell, No. of feet front ........................: No. of feet deep ........................ No. of feet high ................._........
15. Size of Lot ...................................................................................Feet Wide .................................... Feet Deep
.................................
16. How near the-line of street ......................................................................................................................... ......».
......... ...............................
17. How near the line adjoining lot. Right .................................; Left....................................; Rear.................................
18. Nearest building is .................................feet in a...................................................... direction ......................................................
19. Material of the floor..........................................................................................».................................................................................
20. Size of timbers, 1st ........................: 2nd ....._................. ; 3rd ........................; 4th ................._...........; 5th ..............................
21. No. of feet span.................................................................. ; Distance on centers ........................................................................
22. Will the building be erected on solid or filled land .............................................................................................................
23. What is the material of foundation ....._......._..................._............._.........._.................................; Footing ...................
24. Will the roof be flat or pitched ........................................................; Covering...................._........................._....................
25. Heat; steam, hot water, furnace, stoves ........................................; Power oil burner ................................................
26. Fireplace ...................................................................: Insulation .............._...............................................................................................
27. How many sinks ............: Toilets ....._.....; Lavatories .........; Bathtubs....._..; Showers............; Settubs .........
28. City Service; Water ........................Sewer .................._....; Road Surface ...........................; Sidewalk ........................
29. Is lot on accepted street ..................................................................................................................................................................
30. Estimated cost (must be filled out) ..................... .O�....................................................................._...............................................
Applicant agrees to give the Inspector of Buildings 24 hours' notice before lathing or
plastering this building. building will conform to the requirements of the law.
Signatureof applica ......... ......... .....�».. _ ... ...., ...............................................................
No.zla.8...._...........
REMARKS
//C�jl
APPLICATION
Address. A(Hrest
Telephone
-o of iotjr ] nd
Frecq PIA Proposed
Mark the appr6printe box to indic�-,te
t11(1 11�:c Of thr
]loo~Cnof `rmioO Ict =ud/nr "'truoture. 3!`eoify~________--__._____-------------
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\ ! Subdlviol,`m pitb ,1ir''!o-3t�mD:
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Planning �onz-d Ayj,rovz�l ;
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Zoning Board Approval
(Sycrinl Permit lo^0: V,rinnom)
= City Council (S i l ti
Parkin- Space Requiremeiitc: MO. ""cct. p..1) Required Propose(I
Loading Space Requirement,p: Requirc-d—Proposed
,Environmental Performancc Standards: ( Z.0, Art. XJJ) =Yes ITO
Plot Plan Yes .To site 111.011 Yes
This nc-ntiou for OFFICIAL noo only:
Q�pproval no l`reoeut,d:
F--lModifinotjnun neuooc:ry fnr ,yprov�l;
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Beturu: (Bore ioformnti"u oepdcd)
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I hereby certify that the proposed work is authorized by,.the owner of record' ""`
and I have been authorized by the owner. to-make this`applieat�on"'Its" his.,
authorized agent.
SIGNATURE OF AGENT
ADDRESS
(NUMBER) (STREET) (CITY)
APPROVED BY TITLE
DATE 19
DEPT. FILE COPY
z
r City of Northampton BUILDING qa
Massachusetts PERMIT VALIDATION
0 ice of the Inspector of Buildings +, Q
DATE , Qom_19_ 6 PERMIT NO. x'28
APPLICANT I)S,IIa_Lll da TAnnysen ADDRESS 106 Brookwood Rd Florence
(N0.) (STREET) (CONTR'5 LICENSE)
rt NUMBER OF
PERMIT TO Chi mm�TriSt�1 �_-) STORY DWELLING UNITS
(TYPE 0 IMPROVEMENT) NO. (PROPOSED USE)
ZONING URA
AT (LOCATION) DISTRICT
(N0.) (STREET)
rn BETWEEN AND
v (CROSS STREET) (CROSS STREET)
LOT
B SUBDIVISION LOT BLOCK SIZE
RI
a
O BUILDING IS TO BE FT. WIDE BY FT. LONG 13Y FT. IN HEIGHT AND SHALL CONFORM IN CONSTRUCTION
O
M
Z TO TYPE USE GROUP BASEMENT WALLS OR FOUNDATION
(TYPE)
I
K
O
IL REMARKS:
AREA OR K PERMIT & 10.00
VOLUME ESTIMATED COST 1 j0 FEE
(CUBIC/SQUARE FEET)
OWNER nale & Linda Te=sen BU
ADDRESS JnA - akwgod Dr Rsy=enoe - B
(Affidavit on reverse side of application to be completed by authorized agent of owner)