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IDENTIFICATION — To be completed by all applicants Name Mailing address — Number, street, city, and State ZIP code Tel. No. Owner a., W �� r 1`ifi' r C7lC►�cj Lessee Builder's 1' 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. Signature of applicant Address Application date 00 NOT WRITE BELOW THIS LINE V. PLAN REVIEW RECORD — For office use Plans Review Required Check Plan Review Date Plans By Plans Fee Started Y Approved BY Notes BUILDING $ PLUMBING $ MECHANICAL $ ELECTRICAL $ OTHER $ VI. ADDITIONAL PERMITS REQUIRED OR OTHER JURISDICTION APPROVALS Permit or Approval Check Date Date pp Obtained Number By Permit or Approval Check Obtained Number By BOILER PLUMBING CURB OR SIDEWALK CUT ROOFING ELEVATOR SEWER ELECTRICAL 7WRECKING OR BIL7ES D FURNACE ET GRA GRADING OF PUBEAS OIL BURN ER OTHER OTHER VII. VALIDATION Building Permit number FOR DEPARTMENT USE ONLY � Building Use Group Permit issued lq Building Fire Grading Permit Fee $ Live Loading Certificate of Occupancy $ Occupancy Load Approved by: Drain Tile 6"tot" Plan Review Fee $ TITLE - CITY OF NORTHAMPTON MASSACHUSETTS OFFICE of the INSPECTOR of BUILDINGS ,VT Page ',v Plot APPLICATION FOR INSPECTOR ZONING PERMIT AND BUILDING PERMIT IMPORTANT — Applicant to complete all items in sections: 1, 11, 111, 1V, and 1X. O I• DISTRICT t T�AT (LOCATION) l� Ii. ZONING 'lqp LOCATION (NO.) (STREET) OF BETWEEN AND BUILDING (CROSS STREET) (CROSS STREET) LOT SUBDIVISION LOT BLOCK SIZE tA II. TYPE AND COST OF BUILDING - A// 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 ❑ Amusement, recreational of new housing units added, if any, in Part D, 13) 13 ❑ Two or more fomily — Enter 19 ❑� Church, other religious number of units— — 20 Industrial — — 3 ❑ Alteration (See 2 above) 14 ❑ Transient hotel, motel, ❑ 4 ❑ Repair, replacement 21 or dormitory — Enter number L Parking garage 5 ❑ Wrecking (If multi family residential, of units ——————— — -- 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 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 (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•,,,,•„........ 500, QZ' 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 I$ 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 Masonry wall bearing) 40 Public or 48. Number of stories................ ❑ y ( g) � private company 31 Wood frame 41 ❑ Private (septic tank, etc.) 49• Total square feet of floor area, X �© 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 F. PRINCIPAL TYPE OF HEATING FUEL I. TYPE OF MECHANICAL 51. Enclosed ....................... 35 ❑ Gas Will there be central air 52. Outdoors........................ 36 ❑ Oil conditioning? L. RESIDENTIAL BUILDINGS ONLY 37 Electricity 44 ❑ Yes 45 i� No 53. Number of bedrooms.............. 38 ❑ Coal _- 39 ❑ Other— Specify Will there be an elevator” Full.......... 54. Nuinber of 46 F1 Yes 47 ❑ No bathrooms Partial.,...... DEPT tIF BULDING INSPECTIONS BUILDING Z° 212 Main Street 'Oa Northampton, MA 01060 PERMIT 36 - 102 VALIDATION William May 6, _ 1 86 yp-,E1 IT NO- 217 APPLICANT William Clayton AOORESS ur S It .Roa Owner (NO.) (STREET) (CONTR'S LICENSE) PERMIT TO Addition (`) STORY Open DECk/One Family DWELLING UNITS (TYPE OF IMPROVEMENT) NO. (PROPOSED USE) AT (LOCATION) 955 Burts Pit UPOO Road D�TR CT (NO.) (STREET) BETWEEN AND (CROSS STREET) (CROSS STREET) LOT SUBDIVISION LOT BLOCK SIZE DECK �3i IS TO BE 12 FT. WIDE BY 20 FT. LONG BY FT. IN HEIGHT AND SHALL CONFORM IN CONSTRUCTION TO TYPE USE GROUP BASEMENT WALLS OR FOUNDATION (TYPE) REMARKS: permit for the addition of an open deck onto rear of existing dwelling AREA OR VOLUME 240 sq. ft. ESTIMATED COST $ 500.00 FEEMIT $ 10.00 (CUBIC/SQUARE FEET) OWNER Same as Applicant ADDRESS Same as Applicant's BBYILD WHITE - FILE COPY . GREEN - FIELD COPY • CANARY - APPLICANT COPY • PINK - ASSESSORS COPY pjNf P