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Bill
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NOTES and Data — (For department use)
IV, IDENTIFICATION — To be completed by all applicants -
Name Mailing aldress — Number, street, city, and State ZIP code Tel. No.
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.
Signet a of applicant ' Address Application date
DO 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 $
OTHER $
VI. 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 l, V/n� FOR DEPARTMENT USE ONLY
Permit number ��l
Building use Group
Permit issued .� 19
Bui Iding ` Fire Grading
Permit Fee $ ltl-) `�`l1 Live Loading
Certificate of Occupancy $ Occupancy Load
Approved by:
Drain Tile $
Plan Review Fee $ `�
TITLE
CITY OF NORTHAMPTON
MASSACHUSETTS
$ OFFICE of the INSPECTOR of BU LDINGS
Page ❑ Plot APPLICATION FOR
INSPECTOR ZONING PERMIT AND
BUILDING PERMIT
z
IMPORTANT — Applicant to complete all items in sections: I, 11, III, IV, and IX. O
1) ZONING
AT (LOCATION) DISTRICT
LOCATION (NO.) (STREET)
OF BETWEEN AND
BUILDING (CROSS STREET) CROSS STREET)
LOT
SUBDIVISION LOT BLOCK SIZE
1/t
il. 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 V-1 New building Residential Nonresidential
2❑ Addition(If residential, enter number 12 One family 18 ❑ 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— — — — i 20 C❑ 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 ——————— — —)a 22 �_� Service station, repair garage
enter number of units in building in 15 �� Garage 23 Hospital, institutional
Part D, 13)
16 Carport 24 L� Office, bank, professional
6 ❑ Moving (relocation)
17 Other — Specify 25❑ Public utility
7 L—] Foundation only
26 School, library, other educational
B. OWNERSHIP 27 Stores, mercantile
8 4 Private (individual, corporation, 28 Tanks, towers
nonprofit institution, etc.) 29 ❑ Other — Specify
9 ❑ Public (Federal, State, or
local government)
C. COST mit cents Nonresidential — Describe in detail proposed use of buildings, e.g., food
(�
processing plant, machine shop, laundry building at hospital, elementary
- t �- P 9 P P. Y 9 P� Y
10. Cost of improvement,,,,,,,,,,,,,,,, `--)GI 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 W.
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 V�_Nood 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 private company 50. Total land area, sq. ft. ........... y(,
43 L❑ 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 conditioning? L. RESIDENTIAL BUILDINGS ONLY
37 Electricity 44 [—] Yes 45 i`7 No 53. Number of bedrooms..............
38 ❑ Coal
39 ❑ Other — Specify Will there be an elevator? 54. Number of Full..........
—
46 C Yes 47 ❑ No bathrooms
Partial........
DEPT. OL&UWING INSPECTIONS BUILDING �O
212 Main Street 0a
Northampton, MA 01060 PERMIT
29 - 84 p VALIDATION
DATE July 22, )g 87 PE MIT NO. 483
APPLICANT Alvin Cohen ADDRESS 11 Acre brook rive, Florence Owner
(NO.) (STREET) (CONTR•S LICENSEI
New Building One Family UMBER OF
PERMIT TO (_) STORY y DWELLING UNITS
(TYPE OF IMPROVEMENT) NO. (PROPOSED USE)
AT (LOCATION) 11 Acrebrook Drive ZONING URA
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 construction of a new storage shed 10' x 6'
AREA OR 830 QO PERMIT 1 D o0
VOLUME 60 sq.. f t. ESTIMATED COST FEE .�
(CUBIC/SQUARE FEET)
C j � y
OWNER Jame as Apgl Kant BUIL
ADDRESS Same as Applicants BY
WHITE - FILE COPY . GREEN - FIELD COPY • CANARY APPLICANT COPY • PINK - SSESSORS COPY pINT I1P