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NOTES and Data — (For department use)
IV. IDENTIFICATION — To be completed by all applicants
Name Mailing address — Number, street, city, and State ZIP code Tel. No.
1.
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.
Si�gnaturAof applica/nt� l Address( �[ Application date
u�. tCc-x //��j„
00 NOT WRITE BELOW 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 Is I
OTHER Is I
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 Q Use Group
Permit issued C:�O 1 19
Building Fire Grading
Permit Fee
Live Loading
Certificate of Occupancy $ Occupancy Load
A roved by:
Drain Tile $ '
Plan Review Fee $ o)
ITLE
CITY OF NORTHAMPTON
8. MASSACHUSETTS
$ OFFICE of the INSPECTOR of BUILDINGS
/V T
Page — Plot APPLICATION FOR
ZONING PERMIT AND
INSPECTOR BUILDING PERMIT
z
IMPORTANT — Applicant to complete all items in sections: 1, 11, III, IV, and IX. 0
�J �/ ZONING
• AT (LOCATION) = r �C-k�1�l � �V�-' DISTRICT
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
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 E7] Two or more family — Enter 19 ❑� Church, other religious
number of units— — — — --> 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) 24 Office, bank, professional
16 ❑ Carport ❑
6 ❑ Moving (relocation)
17 �(� Other — Specify 3 t.i I/)Z 221 t R r: JG��S�� Public utility
7 Foundation only t 26 School, library, other educational
p /
B. OWNERSHIP
�V xc (' 27 Stores, mercanti le
28 ❑ Tanks, towers
8 DX Private (individual, corporation,
nonprofit institution, etc.) 29 L7 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................ (�6-, 0 CU 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 $
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
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
34 ❑ Other — Specify 42 ❑ Public or pr,vate 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 1. TYPE OF MECHANICAL
35 ❑ Gas Will there be central air 52. Outdoors........................
36 ❑ Oil conditioning) L. RESIDENTIAL BUILDINGS ONLY
37E] Electricity 44 ❑ Yes 45 No 53. Number of bedrooms..............
38 L❑ Coal
39 Other — Speci%y Will there be an elevator ,.
❑ 54. Number of Full.......
46 Yes 47 '❑ N o
bathrooms
Partial.......
��. A �
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bE0#.' UILDING INSPECTIONS BUILDING z_
! 212 Main Street o<
Northampton, MA 01060 PERMIT <a
29 - 20 VALIDATION
DATE XROXIX MAY 1�, 19 ��gg� PER T NO. 271 ewner
APPLICANT Thomas & Nancy Lippie ADDRESS `7l'�i1•'�lcory ��'.
(NO.) (STREET) (CONTR'S LICENSE)
PERMIT TO
In-Ground POOL(_) STORY One Family DWELLING UNITS
(TYPE OF IMPROVEMENT) NO. (PROPOSED USE) p
29 Hickory Drive ZONING se
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 the installation of a in-ground pool 18' X 36'
AREA OR 5,000-00 PERMIT 10.00
VOLUME ESTIMATED COST FEE
(CUBIC/SQUARE FEET)
OWNER Same as Applicants
BUI ;;;i
AD DRESS _ Same as Applicants' BY
WHITE - FILE COPY • GREEN - FIELD COPY • CANARY - APPLICANT COPY • PINK - ASSESSORS COPY Pixr'sliP