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IDENTIFICATION — To be completed by all applicants Name Mailing address — Number, street, rite, and .State ZIP code Tel. No. 1. W 3Q Owner or 0?6 Lessee ((/ Builder's 2. ll r License No. Controctor l� 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 lows of this jurisdiction. Signot app nt Address Application dote 0/0 i6 io 00 NOT WRITE BELOW THIS LINE 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 Permit or Approval Check Obtained Number By Permit 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 11. VALIDATION Building FOR DEPARTMENT USE ONLY Permit number Building. use Group Permit issued 19 Building � Fire Grading Permit Fee $ Live Loading Certificate of Occupancy $ Occupancy Load Approved by: Drain Tile $ Plan Review Fee $ / T E CITY OF NORTHAMPTON MASSACHUSETTS $ OFFICE of the INSPECTOR of BUILDINGS Page �g Plot a APPLICATION FOR INSPECTOR ZONING PERMIT AND BUILDING PERMIT IMPORTANT — Applicant too/complete all items in sections: I, II, Ill, IV, and IX. O ZONING I• AT (LOCATION) ��-/ /TTIp�° ( D STR CTq LOCATION (NO.) (S REET) OF BETWEEN AND BUILDING (CROSS STREET) (CROSS STREET) LOT SUBDIVISION LOT `ter BLOCK SIZE N 11. TYPE AND COST OF BUILDING — All applicants complete Parts A — D A. TYPE OF IMPROVEMENT D. PROPOSED USE — For"Wrecking" most recent use m 1 New building ResidenpLdl Nonresidential 2 ❑ Addition(!/residential, enter number 12 One family 18 ❑ Amusement, recreational of new bousing 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 ❑ Transient hotel, motel, 21 parkin 4❑ Repair, replacement or dormitory — Enter number 9 garage 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, 16 ❑ Carport 24❑ Office, bank, professional 6❑ Moving (relocation) p 17 ❑ Other — Specify 25 ❑ Public utility 7 ❑ Foundation only 26 ❑ School, library, other educational B. OWNVSHIP 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 $ Ill. 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 SEWAGE DISPOSAL J. DIMENSIONS 30 asonry (wall beoring) 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 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 ,r� F. PRINCJPAL TYPE OF HEATING FUEL 1. TYPE OF MECHANICAL 51. Enclosed ...................... � 35 Gas Will there be central air 52. Outdoors........................ 36 ❑ Oil conditioning? _ L. RESIDENTIAL BUILDINGS ONLY 37 Electricity 44 C❑ Yes 45 /M 53. Number of bedrooms.............. 38 Coal 39 Other — Specify Will there be an❑ elevatorvt4 Full.......... 54. Number of 46 [ Yes 47 bathrooms — Partial......, DEPT�10 ILDING INSPECTIONS BUILDING ZO V` Z)D 212 Main Street Oa Northampton, MA 01060 PERMIT ' 29 - 208 VALIDATION DATE October 15, 19 84 PERMIT NO. 577 APPLICANT Robert H. Scott ADDRESS_ R348 A Williamsburg 42 7 3T (NO.) (STREET) (CONTR'S LICENSE) New Building ne Family ome NUMBER OF 1 PERMIT TO (�) STORY y DWELLING UNITS ((TYPE OF IMPROVEMENT) NO. (PROPOSED USE) AT (LOCATION) Lot Acrebrook Drive ZONING CT (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 SMALL CONFORM IN CONSTRUCTION TO TYPE USE GROUP BASEMENT WALLS OR FOUNDATION const coon (TYPE) REMARKS, Permit for the � of a new one family home with a attached garage beneath existing home AREA OR 1054 sq. ft. 51,300.00 PERMIT 513.00 VOLUME ESTIMATED COST $ FEE (CUBIC/SOUARE FEET) OWNER Same As Applicant BUILDIN ADDRESS BY WHITE - FILE COPY . GREEN - FIELD COPY • CANARY - APPLICANT COPY • PIN ASSESSORS COPY PjRf 'P