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NOTES and Data — (For department use)
O4�NAAtp�O
(�if� of wort 1jampt-011
uB �lnaaarltuartta
DEPARTMENT OF BUILDING INSPECTIONS
INSPECTOR 212 Main Street ' Municipal Building
Northampton, Mass. 01060
AS A HOMEOWNER I UNDERSTAND THAT I MAY APPLY FOR AND RECEIVE
A BUILDING PERMIT FOR A HOME OR ADDITION I INTEND TO LIVE IN.
I ALSO UNDERSTAND THAT I AM RESPONSIBLE FOR KNOWING THE STATE
BUILDING CODE AND ZONING ORDINANCE OF THE CITY OF NORTHAMPTON.
rEING A HOMEOWNER AND NOT A PROFESSIONAL CONTRACTOR IN NO WAY
ABSOLVES ME OF ANY RESPONSIBILITY TO INSURE THAT ALL FACETS
OF THE RULES AND REGULATIONS ARE COMPLIED WITH.
v .
s
IV. IDENTIFICATION — To be completed by all applicants
Name Mailing address — Number, stmt, city, and State ZIP code Tel. No.
1. E✓ I j / M 0 i 0 &0
owner or , y o �7 3 rya`s F3
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 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 Is
OTHER is
VI. ADDITIONAL PERMITS REQUIRED OR OTHER JURISDICTION APPROVALS
Permit or Approval Check Date Number B Permit or Approval I Check Dote Number B
Obtained y pp Obtained 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
VII. VALIDATION
Building FOR DEPARTMENT USE ONLY
Permit number
Building Use Group
Permit issued - i 19
Building Fire Grading
Permit Fee $
Live Loading
Certificate of Occupancy $ Occupancy Load
Approved by:
Drain Tile
Plan Review Fee $
y ITLE
CITY OF NORTHAMPTON
�. MASSACHUSETTS
e OFFICE of the INSPECTOR of BUILDINGS
Page 3 � Plot ` APPLICATION FOR
ZONING PERMIT AND
INSPECTOR BUILDING PERMIT
z
IMPORTANT - Applicant to complete all items in sections: 1, 11, 111, IV, and IX. O
ZONING r� 3
I• AT (LOCATION) DISTRICT ar
LOCATION (NO.) 1 (STREET) vv
OF BETWEEN
F 1-y�\rev/�—C 2" !y• AND
�� l ��tRr�l 5 Ci
BUILDING (CROSS STREET) (CROSS STREET)
LOT
SUBDIVISION LOT BLOCK SIZE
N
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
1 ❑ New building Residential Nonresidential
2 ❑ Addition(// residential, enter number 12 One family 18 L❑ Amusement, recreational
of new housing units added, if any,
in Part D, 13) 13 �� Two or more family - Enter 19 ❑� Church, other religious
�Repair, number of units- - - - 20 �� Industrial
3Alterotion (Sec: 2 above) 14 Transient hotel, motel,❑ 21 i 1 Parking garage
4 L replacement or dormitory - (inter number
5 ❑ Wrecking (11 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) 24 'I, l Office, bank, professional
6 ❑ Moving (relocation) 16 L_ Carport
17 L_ Other - Sped/y_ _ 25 � � Public utility
7 ❑ Foundation only ) 26 r f School, library, other educational
B. OWNERSHIP L'2 rS f 27 Stores, mercantile
8 Private (individual, corporation, ` 28 Tanks, towers
nonprofit institution, etc.) ( C^ ? 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,,,,,,,,,,,,,, school, secondory 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 charged, enter proposed use.
in the above cost
a. Electrical.......................
b. Plumbing .......................
c. Heating, air conditioning.......
d. Other (elevator, etc.).............
11. TOTAL COST OF IMPROVEMENT
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 j Public or private company
49. Total square feet of floor area,
31 ❑ Wood frame 41 r j Private (septic tank, etc.) all floors, based on exterior
32 ❑ Structural steel dimensions .....................
33 J Reinforced concrete H. TYPE OF WATER SUPPLY
--- 50. Total land area, sq. ft. ...
34i❑ Other - Specify 42 Public or private company
43 Private (well, cistern) K. NUMBER OF OFF-STREET
PARKING SPACES
51. Enclosed .......................
F. PRINCIPAL TYPE OF HEATING FUEL I. TYPE OF MECHANICAL
35 Gas Will there be central air 52. Outdoors........................
'1 36 � I Oil L. RESIDENTIAL BUILDINGS ONLY
37 j Electricity 44 r Yes 45 _ No 53. Number of bedrooms..............
38 ❑I Coal
39 'L_ Other - Specify Will there be an elevators Full..........
54. Number of
46 [_� Yes 47 '❑ Nc bathrooms Partial........
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