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NOTES and Data — (For department use)
IV. IDENTIFICATION — To be completed by all applicants
Name Mailing address — Number, stmt, city, and State ZIP code Tel. No.
Owner or , r1C� �e, / '_ •��
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
e'
00 NOT WRITE BELOW THIS LINE
V. PLAN REVIEW RECORD — For office use
Plans Review Required Check Plan Review Date P y Ions B Date Plans By Notes
Fee Started Approved
BUILDING $
PLUMBING $
MECHANICAL $
ELECTRICAL Is
OTHER $
VI. ADDITIONAL PERMITS REQUIRED OR OTHER JURISDICTION APPROVALS
Permit or Approval Check Date Number By Permit or Approval Check Date Number B
Obtained 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
Permit issued C��. 19-- �- — Use Group
Building 1 Fire Grading
Permit Fee
Live Loading
/'-
Certificate of Occupancy $ 0 cupancy Load
Approv y:
Drain Tile $ �/'
Plan Review Fee $
TITLE
CITY OF NORTHAMPTON
r
MASSACHUSETTS
OFFICE of he INSPECTOR of BUILDINGS �� l
Page Plot - ( APPL I CATION FOR
INSPECTOR I NG PERMIT AND
Q� /w tiro C
BUILDING PERMIT
z
IMPORTANT — Applicant to complete all items in sections: 1, 11, 111, IV, and IX. 0
�'sN / r t ,+� ZONING
I• AT (LOCATION) j�«f-,-/' J�T_ J� - DISTRICT
LOCATION (NO.) (STREET)
OF BETWEEN_ AND
BUILDING CROSS STREET) CROSS STREET)
LOT
SUBDIVISICN LOT BLOCK SIZE
f/t
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 Reside tial Nonresidential
2 Addition(►/ residential, enter number 12 7ne family 18 Amusement, recreational
of new housing units added, if any,
in Part D, 13) 13 Two or more family — Enter 19 n Church, other religious
number of units— — — — 20 Industrial
3A Alteration (See 2 above)
14 Transient hotel, motel,
21 C� Parking garage
4 L] Repair, replacement or dormitory — Enter number
5 El Wrecking (if multifamily residential, of units ——————— — -i 22 L] Service station, repair garage
enter number of units in building in 15 L� Garage 23 n Hospital, institutional
Part D, 13)
16 Carport 24 L� Office, bank, professional
6 Ej Moving (relocation)
17 E_j Other — SpeciJy 25 E_1 Public utility
7 n Foundation only
26 L� School, library, other educational
B. OWNERSHIP 27 Stores, mercantile
8 Private (indivicual, corporation, 28 Tanks, towers
nonprofit institution, etc.) 29 n Other — Specify
9 Public (Federa , 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 irstallcd but not included If use of existing building is being changed, enter proposed use.
in the above cost
a. Electrical....................... 4 -
b. Plumbing
c. Heating, air conditioning..........
s
d. Other(elevator, etc.).............
11. TOTAL COST OF IMPROVEMENT $
III. SELECTED CHARACTERISTICS OF WILDING — 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,
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
51. Enclosed .......................
F. PRINCIPAL TYPE OF HEATING FUEL J. TYPE OF MECHANICAL
35 D Gas Will there be central air 52. Outdoors........................
36 7] Oil conditioning? L. RESIDENTIAL BUILDINGS ONLY
37 � Electricity 44 F-] Yes 45 No 53. Number of bedrooms..............
38 Coal
39 Other — Specify Will there be an elevators 54. Nuir, Full..........
ber of
46 Yes 47 No bathrooms
Partial......
D BUILDING INSPECTIONS
BUILDING 4 t
z
JIL C
212 Main Street o<
Northampton, MA 01060 PERMIT
29 - 59
VALIDATION
Richard Booth DATE 1L11�2R, -� 1 Rai ferr.'T No 480 ...,"
APPLICANT ADDRESS Owner
IND.) (STREET) (CONTR'S LICENSE)
PERMIT TO Alteration (_) STORY One Family NUMBER NG UNITS
(TYPE OF IMPROVEMENT) NO. (PROPOSED USE)
62 Gilrain Terr. , Florence ZONING UKA
AT (LOCATION) DISTRICT
(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 SHALL CONFORM IN CONSTRUCTION
TO TYPE USE GROUP BASEMENT WALLS OR FOUNDATION
(TYPE)
REMARKS: _ permit for new basement entrance way (sliding glass doors) , and a new handicap ramp with
retaining walls
AREA OR PER
VOLUME XXXXX ESTIMATED COST $ 2,500.00 FEEM 10.00
(CUBIC/SQUARE FEET)
OWNER Samp as Applicant
ADDRESS Samp as Upl icant l s ByILDI
WHITE - FILE COPY . GREEN - FIELD COPY • CANARY - APPLICANT COPY • PINK ASSESSORS COPY QP