35-218 (5) ZONING •
DISTRICT
FRONT YARD
IX. SITE OR •
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NOTES and Data — (For department use)
IV, IDENTIFICATION — To be completed by all applicants
Nome Mailing address — Number, street, city, and State ZIP code Tel. No.
� 1
Owner or
Lessee
Builder's
2 1 License No.
Contractor
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 appl'cant Address Application date
�-,4L , - 3 ,
00 NOT WRITE BELOW THIS LINE
V. PLAN REVIEW RECORD — For office use
Plans Review Re uired Check Plan Review Date Plans By y
Date Plans B Notes
q Fee Started Approved
BUILDING $
PLUMBING $
MECHANICAL $
ELECTRICAL $
OTHER Is
VI. ADDITIONAL PERMITS REQUIRED OR OTHER JURISDICTION APPROVALS
Date Date
Permit or Approval Check Obta ned 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 �u7��+� ,yX .<� ! 19
Building Fire Grading
�Permit Fee $��1 7 , n�y Live Loading
Certificate of Occupancy $ Occupancy Load
A r ed by:
Drain Tile $
Plan Review Fee $
TITLE
CITY OF NORTHAMPTON
�• e� MASSACHUSETTS
$ OFFICE of the INSPECTOR of BUILDINGS
Page f' Plot APPLICATION FOR
INSPECTOR ZONING PERMIT AND
BUILDING PERMIT
IMPORTANT - Applicant to complete all items in sections: I, II, 111, IV, and IX. O
ZONING
I• AT (LOCATION) !�� '�. t`�i�t S/% /� �.Ct/��C DISTRICT
LOCATION if�I/NN 0,1.)' /J) Y /i/ (STREET) p
OF BETWEEN 6�tE WeSQ �tGll 'J�.G'I ++�-<<-.l `^ F.• !r: lC AND
BUILDING (CROSS STREET) (CROSS STREET),
SUBDIVISION I,-) �G' !rt✓�G � LOT �U_BLOCK SIZE u �
CA
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
rn
1w building Resident' Nonresidential
2 ❑ Addition(It 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— — — — -� 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 ——————— — --0 22 ❑ Service station, repair garage
enter number of units in building in 15 ❑ Garage 23❑ Hospital, institutional
Part D, 13)
6 Moving (relocation) 16 ❑ Carport 24❑ Office, bank, professional
❑
17 ❑ Other — Specify 25❑ Public utility
7 L❑ Foundation only 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 (0 7P c nts) Nonresidential— Describe in detail proposed use of buildings, e.g., food
7[ `'0 processing plant, machine shop, laundry building at hospital, elementary
10. Cost of improvement,,,,,,,,,,,,,,,, mow. 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.
to the above cost
a. Electrical..................... -
b. Plumbing ....................
c. Heating, air conditioning........
d. Other(elevator, etc.)............ K
11. TOTAL COST OF IMPROVEMENT $ x`�
III. SELECTED CHARACTERISTICS OF BUI DING - 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❑M my (wall bearing) 40 ❑ P tic or private company 48• Number of stories............... -
31 ood 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. ...........
43 ❑ Private (well, cistern) K. NUMBER OF OFF-STREET
PARKING SPACES
51. Enclosed .......................
F. PRINCIPAL TYPE OF HEATING FUEL I. TYPE OF MECHANICAL
35 Ga• Will there be central air 52. Outdoors........................
36 1❑ U i I conditio ng?
��-�J' L. RESIDENTIAL BUILDINGS ONLY �
37 ❑ Electricity 44 Yes 45 r"`No 53. Number of bedrooms.............. ']
38 ❑ Coal
39 C❑ Other — Specify Will there be an elevator" Full.......... L--
54. Number of
46 [—] Yes 47[71 No bathrooms
Partial.......
DEPT. OF BUILDING INSPECTIONS BUILDING `°
212 Main Street 04 $693.05
I IL
Northampton, MA 01060 PERMIT 9
Qj Q �7. �g j ��� �1 VALIDATION
DATE November 9 Ig $4 PERMIT NO. 630
APPLICANT, ADDRESS
6 Industry Ave. , SpringfieldF 3'a'nt;
1N0.1 (STREET) (CONTR'S LICENSE)
PERMIT TO New Building (_) STORY One Family Home NUMBER OF
DWELLING UNITS 1
(TYPE OF IMPROVEMENT) NO. (PROPOSED USE)
21 Lady Slipper Lane ZONING SR
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
ITrPE)
REMARKS: permit for the construction of a new one family home
AREA OR 1,900 sq. ft• ESTIMATED COST $ 93,350.00 FEEMIT $ 693.05
VOLUME
(CUBIC/SQUARE FEET)
e
OWNER BUILDING DEPT.
•f 7
ADDRESS BY
WHITE - FILE COPY . GREEN - FIELD COPY • CANARY - APPLICANT COPY ■ PINK - ASSESSORS COPY pomp