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NOTES and Data — (For department use)
IV. IDENTIFICATION — To be completed by all applicants
Name Mailing address — ;Yumber, street, city, and Stale 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
00 NOT WRITE B LOW THIS LINE
V. PLAN REVIEW RECORD — For office use
Plans Review Required Check Plan Review Date Plans B Date Plans B Notes
Fee Started y Approved y
BUILDING $
PLUMBING $
MECHANICAL $
ELECTRICAL $
OTHER $
V1. ADDITIONAL PERMITS REQUIRED OR OTHER JURISDICTION APPROVALS
Permit or Approval Check Date Number B Permit or Approval Check Date
By Number Obtained pp N b By
y
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
Permit number �` FOR DEPARTMENT USE ONLY
`
Building. Use Group
Permit issued 1q —
Building ,,ll Fire Grading
Permit Fee $
Live Loading
Certificate of Occupancy $ Ap Occupancy Load
pr by:
Drain Tile $
Plan Review Fee $
TITLE
�o� o CITY OF NORTHAMPTON
MASSACHUSETTS
OFFICE of the INSPECTOR of BUILDINGS
Page 3L C' Plot 3is' APPLICATION FOR
ZONING PERMIT AND
INSPECTOR BUILDING PERMIT
z
IMPORTANT — Applicant to complete all items in sections: 1, 11, Ill, IV, and IX. O
/ ZONING [J�
//�'/�'�/�L� ST
I• AT (LOCATION) DISTRICT�'
�
LOCATION `"O•) (STREET
OF BETWEEN (CROSS S AND
BUILDING STREET) (CROSS STREET)
LOT
SUBDIVISION LOT BLOCK SIZE
V1
II. TYPE AND COST OF BUILDING — All applicants complete Parts A — D A
A. TYPE OF IMPROVEMENT D. PROPOSED USE - For"Wrecking" most recent use m
m
1 ❑ New building Residential Nonresidential
2 Addition(If 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 L❑ Church, other religious
number of units- - - - -i 20 Industrial
3 ❑ Alteration (See 2 above) 14 Transient hotel, motel,
❑ 21 �❑ Parking garage
4 ❑ Repair, replacement or dormitory - Enter number
5 ❑ Wrecking (If multifamily residential, of units ------- - -i 22 Service station, repair garage
enter number of units in building in 15 ® Garage 23 ❑ Hospital, institutional
Part D, 13) 16 Carport
24 ❑ Office, bank, professional
❑
6 Moving (relocation) 25 ❑ Public utility
_ 17 ❑ Other - Sped/y
7 ❑ Foundation only ` 26 ❑ School, library, other educational
B. OWNERSHIP 27 ❑ Stores, mercantile
28 ❑ Tanks, Towers
8 Private (individual, corporation, �� J Ae
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,,,,,.,,,•...... 76�0 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 $ 7CJCJ
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
48. Number of stories................
30 ❑ Masonry (wall bearing) 40 Public or private company
41 ❑ Private (septic tank, etc.) 49. Total square Feet n floor area,
31 � Wood frame all floors, based on exterior
32 ❑ Structural steel dimensions .....................
33 ❑ Reinforced concrete H. TYPE OF WATER SUPPLY
50. Total land area, sq. ft. ..........
34 ❑ Other - Specify
42 Public or private company
43 ❑� Private (well, cistern) K. NUMBER OF OFF-STREET
PARKING SPACES J
51. Enclosed .......................
F. PRINCIPAL TYPE OF HEATING FUEL I. TYPE OF MECHANICAL
35 L_j Gas
Will there be central air 52. Outdoors........................ /
36 oil conditioning?
L. RESIDENTIAL BUILDINGS ONLY
37F_j Electricity 44 l__� Yes 45 No 53. Number of bedrooms..............
38 J Coal
39 Other - Specify Will there be an elevator? 54. Number of Full..........
46 Yes 47 No bathrooms
Partial.......
INSPECTION RECORD
DATE NOTE PROGRESS - CRITICISMS AND REMARKS INSPECTOR
l-#-•.x FIELD COPY
BUILDING
,ifs PERMIT
DATE 19
APPLICANT ADDRES
r (NO.) TREET) (CONTR'S LICENSE)
NUMBER OF )
PERMIT TO (_) STORY DWELLING UNITS
(TYPE OF IMP OVEMENT) NO. (PROPOSED USE)
ZONING
AT (LOCATION) DISTRICT I
(NO.) (STREET}
a, BETWEEN AND 1
(CROSS STREET) (CROSS STREET)
)
n
m SUBDIVISION LOT BLOCK LOT
SIZE
a
U
O BUILDING IS TO BE FT. WIDE BY FT. LONG BY FT. IN HEIGHT AND SHALL CONFORM IN CONSTRUCTION
m
O �
Z TO TYPE USE GROUP BASEMENT WALLS OR FOUNDATION
f (TYPE)
O:
O
tL REMARKS:
1
AREA OR PERMIT /0"00 j
VOLUME ESTIMATED COST $ FEE
I UBIC/SQUARE FEET)
OWNER BUI NG
ADDRES BY