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NOTES and Data — (For department use)
s
IV. IDENTIFICATION — To be completed by all applicants
Name Mailing address — Number, street, city, and State pZIP code Tel. No.
� v!U('9 v V' T,
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 f applicant
� I 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 B Notes
Fee Started Approved Y
BUILDING $
PLUMBING $
MECHANICAL $
ELECTRICAL Is I
OTHER Is I
V1. ADDITIONAL PERMITS REQUIRED OR OTHER JURISDICTION APPROVALS
Permit or Approval Check Date Number B Permit or Approval Check Date Number B
Obtained y pp Obtained 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 FOR DEPARTMENT USE ONLY
Permit number
Bui[ding- Use Group
Permit issued w> `�� 19 _
Building Fire Grading
Permit Fee $ '/-0 r L
Live Loading
Certificate of Occupancy $ Occupancy Load
roe by:
$
Drain Tile 1
Plan Review Fee $
TITLE
CITY OF NORTHAMPTON
�•;� MASSACHUSETTS
OFFICE of the INSPECTOR of BUILDINGS
Page I;ks— Plot 101S APPLICATION FOR
ZONING PERMIT AND
INSPECTOR BUILDING PERMIT
z
IMPORTANT — Applicant to complete all items in sections: I, 11, III, IV, and IX. O
�I 44 /K--)s ZONING
I• AT (LOCATION) �—' DISTRICTW&A
LOCATION (NO.) (STREET)
OF BETWEEN —AND
BUILDING (CROSS STREET) (CROSS STREET)
LOT
SUBDIVISION LOT_ BLOCK SIZE
V1
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 ❑ Addition(If 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
3 Alteration (See 2 above)
number of units– – – – --� 20 ❑� Industrial
❑
14 ❑ Transient hotel, motel, 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) ❑
16 Carport 24 ❑ Office, bank, professional
6 ❑ Moving (relocation)
17 ❑ Other - Specify — 25 ❑ Public utility
7 ❑ Foundation only r
7 26 ❑ School, library, other educational
B. OWNERSHIP 27 ❑ Stores, mercantile
8 Private (individual, corporation, 28 ❑ Tanks, towers
nonprofit institution, etc.) 29 ❑ Other – Specify
9 C❑ 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, 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.)............. j
11. TOTAL COST OF IMPROVEMENT $ 0 T
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 Wood frame 41 ❑ Private (septic tank, etc.) 49• Total square feet of floor area, O
all floors, based on exterior / 0 o
32 Structural steel dimensions ................... �J
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
51. Enclosed .......................
F. PRINCIPAL TYPE OF HEATING FUEL I. TYPE OF MECHANICAL
35 ❑ Gas Will there be central air 52. Outdoors........................
36 ❑ Oil onditioning? L. RESIDENTIAL BUILDINGS ONLY
37 C f Electricity 44 Yes 45 ❑� No 53. Number of bedrooms.............
38 ❑ Coal
39 Other – Specify Will there b an elevator? Full..........
54. Number of
46 es 47 [j No bathrooms
Partial.,.....
Department of Buildilnb tir.spections
212 'fain Street BUILDING
Northarilpton, _i ass: 01060 PERMIT -Ea.
35 -� 95 a c ,
VALIDATION
DATE June 15. _ie Al PERMIT NO. 2$5
APPLICANT Nc'C2Icy M_ Bow Ter ADDRESS_ ET(STRE _
(NO.) (CONT ' LICENSE)
Aux. Building NUMBER OF
PERMIT TO (_) STORY DWELLING UNITS
(TYPE OF IMPROVEMENT) NO. (PROPOSED USE)
ZNING
AT (LOCATION) 15 Cahil Labe Torracp D!STR CT_ ljg_A_
(NO.) (STREET)
BETWEEN AND,
(CROSS STREET) (CROSS STREET)
LOT
SUBDIVISION LOT BLOCK SIZE
BUILDING IS TO BE 18 FT. WIDE BY A FT. LONG BY FT. IN HEIGHT AND SHALL CONFORM IN CONSTRUCTION
TO TYPE USE GROUP BASEMENT WALLS OR FOUNDATION
(TYPE)
REMARKS:perad t to build a auzilary building
AREA OR 141 � 895.00 PERMIT $ 10.00
VOLUME ESTIMATED COST FEE
(CUBIC/SQUARE FEET)
OWNER Nancy M. Bowler KOM
ADDRESS a .l�.lane Terrace BU 1
WHITE - FILE COPY . GREEN - FIELD COPY • CANARY - APPLICANT COPY PINK - SSESSORS COPY