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DISTRICT
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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 (j(U 6 Q
Lessee
2. Z 5 Qt? zl I J LiicenserNo.
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.
Sign ture of applicant Address Application date
2It1-Uf1-l�'G
00 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
Permit or Approval Check Obttaain d Number By Permit or Approval Check Obttatred 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
II. VALIDATION
Building FOR DEPARTMENT USE ONLY
Permit number
Building Use Group
Permit issued T C�T 19�
Building Fire Grading
Permit Fee $
Live Loading
Certificate of Occupancy $ Occupancy Load
Approved by:
Drain Tile $
Plan Review Fee $
TITLE
CITY OF NORTHAMPTON
9 $ MASSACHUSETTS
${� s OFFICE of t INSPECTOR of BUILDINGS
C 9
Page Plot APPLICATION FOR
INSPECTOR ZONING PERMIT AND
B.QI LDING PERMIT
z
IMPORTANT — Applicant to complete all items in sections: I, 11, 111, IV, and IX. O
ZONING
I•
AT (LOCATION) J Lf" 1 `r`� rIrLr— �� IViz— DISTRICT
LOCATION (NO.) (STREET)
OF BETWEEN AND
BUILDING CROSS STREET) (CROSS STREET)
LOT
SUBDIVISION LOT BLOCK SIZE
Vf
II. TYPE AND COST OF BUILDING — Aff applicantsr complete Parts A — D
A. TYPE OF IMPROVEMENT D. PROPOSED USE — For"Wrecking" most recent use m
M
1New building Residential Nonresidential
2 Addition(l/ 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 n Church, other religious
number of units— — — — _10- 20 n Industrial
30 Alteration (See 2 above)
14 Transient hotel, motel, 21 Parking garage
4 Repair, replacement or dormitory — Enter number
5 ❑ Wrecking (it 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 D Office, bank, professional
6 Moving (relocation)
17 Other — SpeciJy 25 D Public utility
7 Foundation only
�) 26 � School, library, other educational
B. OWNERSHIP �1 L� 27 ❑ Stores, mercantile
8 Private (individual, corporation, 28 Tanks, towers
nonprofit institution, etc.) &14, �1� 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................ l�? 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 $ U
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 1V.
E. PRINCIPAL TYPE OF FRAME G. TYPE OF SEWAGE DISPOSAL J. DIMENSIONS
30 Masonry (wall bearing) 40 Fj Public or private company 48. Number of stories..............
31 Wood frame 41 Private (septic Conk, etc.)
49. Total square feet of floor area,
r all floors, based on exteri
32 Structural steel IZ dimensions ..............or....... C
33 Reinforced concrete H. TYPE OF WATER SUPPLY
34 Other — Specify 42 n 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 1, TYPE OF MECHANICAL
35 E] Gas Will there be central air 52. Outdoors........................
conditioning?
36 El Oil �.�/ L. RESIDENTIAL BUILDINGS ONLY
37 Electricity 1t r' 44 D Yes 45 No 53. Number of bedrooms.............. e
38 � Cool
W �Kf T `
39 Other — Specify Will there be on elevators f=ull..........
54. Number of
46 Yes 47 No bathrooms
Partial........
DEPT. OF*IJILDING INSPECTIONS BUILDING f
z°
! 212 Main Street 'Q `
Northampton, MA 01060 PERMtT a
VALIDATION
36 - 9 458
GATE_ August 'Z> 19 86 PERMIT NO.
APPLICANT Norman O. Sawin ADDRESS 46 Forest Glen Drive Owner
(NO.) (STREET) (CONTR'S LICENSE)
NUMBER OF
PERMIT TO New Building (_) STORY Storage Shed DWELLING UNITS
(TYPE OF IMPROVEMENT) NO. (PROPOSED USE)
ZONING AT (LOCATION) 46 Forest Glen Drive D STR CT URA
(NO.) (STREET)
BETWEEN AND
(CROSS STREET) (CROSS STREET)
LOT
SUBDIVISION LOT BLOCK SIZE
BUILDING IS TO BE R FT. WIDE BY 12 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 storage shed
AREA VOLUME q6 SQ. ft._ ESTIMATED COST $ 530.00 FEEMIT .� 0.00
(CUBIC/SQUARE FEET)
OWNER Samp as Af,r)1lrant BUILDI
ADDRESS Same as A66l l cant' s BY joze�d4rx�l�
WHITE - FILE COPY . GREEN - FIELD COPY • CANARY - APPLICANT COPY • PINK 4SESSORS COPY PjNT- P