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NOTES and Data — (For department use)
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a
IV. IDENTIFICATION — To be completed by all applicants
Name Mailing address — Number, street, city, anri State ZIP code �Tek—No,.
Owner or
Lessee
Builder's
`L.
O .�•�..• License No.
Contractor
3.
Architect or
Engineer
1 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 a icant Address Application date
D NOT WRITE BELOW THIS LINE
V. PLAN REVIEW RECORD — For office use
Plans Review Re wired Check Plan Review Date Plans B Date Plans B Notes
9 Fee Started y Approved y
BUILDING $
PLUMBING $
MECHANICAL $
ELECTRICAL $
OTHER $
V1. ADDITIONAL PERMITS REQUIRED OR OTHER JURISDICTION APPROVALS
Date Date
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
VII. VALIDATION
Building FOR DEPARTMENT USE ONLY
Permit number
Building- Use Group
Permit issued /Z 19 tige
Bui(ding /O. 0 U
Fire Grading
Permit Fee $ G Live Loading
Certificate of Occupancy $ Occupancy Load
ed by:
Drain Tile $ Ap"
Plan Review Fee $
TITLE
i
CITY OF NORTHAMPTON
4,0 MASSACHUSETTS
OFFICE of the INSPECTOR of BUILDINGS
Page Plot Z "
APPLICATION FOR
ZONING PERMIT AND
INSPECTOR BUILDING PERMIT
IMPORTANT — Applicant to complete all items in sections: I, II, III, IV, and IX. O
4 ZONING
I•
URA
AT (LOCATION) • DISTRICT
LOCATION (N 0.) `STREET)
OF BETWEEN AND
BUILDING (CROSS STREET) (CROSS STREET)
LOT
SUBDIVISION LOT BLOCK SIZE
V1
II. TYPE AND COST OF BUILDING — A11 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 D Amusement, recreational
of new housing units added, if any,
in Part D, 13) 13 Two or more family — Enter 19 Church, other religious
number of units— — — — --> 20 n Industrial
3 � Alteration.(See 2 above) 14 Transient hotel, motel, 21 Parking garage
u
4 R�pair, repl�t or dormitory — Enter number
5 Wrecking (/J 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) P
7 � Foundation only 17�� Other — Specify 25 n Public utility
26 School, library, other educational
B. OWNERSHIP 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................ V40d•00 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 $��� '0C)
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 E 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 n Structural steel dimensions .....................
33 F Reinforced concrete H. TYPE OF WATER SUPPLY
34 E 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 �j Gas Wil here be central air 52. Outdoors........................ Q
36 Oil Condit ning?
L. RESIDENTIAL BUILDINGS ONLY
37 Electricity 44 Y. 5
�� _�� No 53. Number of bedrooms..............
38 Coal
39 '� Other — Specify Will there a an ele r? Full.......
54. Number of
46 Yes 47 _ No bathrooms
Partial.......
INSPECTION RECORD
DATE NOTE PROGRESS - CRITICISMS AND REMARKS INSPECTOR
DEPPI UIT OF wnDue ImSPEC"ut31IS FIELD COPY
212 WJN SUM BUILDING
WTOM01M. MA. 01060 PERMIT
29 - sx
DATE ;Mmlmrv� 19 a_ PERMIT NO. 13
APPLICANT _ PohBrt Sto tfs t ADDRESS Piste VAMI ► Rd. Fla.(N0.) (STR E (CONTR'S LICENSE)
PERMIT TO ) STORY Bwaid.,MCe DWELLING UNITS
(TYP OF ( ROVEMENT) (PROPOSED USE)
ZONING
AT (LOCATION) racet flarame DISTRICT
(NO.) STREET) -IV rn BETWEEN A D
(CROSS STREAT)_ If 4 (CROSS STREET)
rn
LOT
D SUBDIVISION LOT BLOCK _SIZE
m
a
O
O BUILDING IS TO BE FT. WIDE BY NG BY FT. IN HEIGHT AND SHALL CONFORM IN CONSTRUCTION
m
O
Z TO TYPE USE GROUP BASEMENT WALLS OR FOUNDATION
F (TYPE)
Ir 1 Ott jy
REMARKS: Redac t ftf fluor ,jeilta- studs, and basemmt 3tatrs. cometic YEA= 1
to fire dasag!
AREA OR PERMIT
VOLUME ESTIMATED COST $ 500.00 FEE $ _
(CUBIC/SQUARE FEET)
)
OWNER refs L*
,ADDRESS 1b [.ilraitt Terrace. Florence. Ma. 01060 BY