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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 B Date Plans B Notes 9 Fee Started y Approved y BUILDING $ PLUMBING $ MECHANICAL $ ELECTRICAL $ OTHER $ V1. ADDITIONAL PERMITS REQUIRED OR OTHER JURISDICTION APPROVALS ate Date Permit or Approval Check ObOtai ed 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 DEPARTMENT USE ONLY Permit number Building Use Group Permit issued .�� ' �� , _ 19 Building Fire Grading Permit Fee $ ��• Live Loading Certificate of Occupancy $ Occupancy Load Approved Drain Tile $ _ } Plan Review Fee $ �(/( TITLE • CITY OF NORTHAMPTON �• MASSACHUSETTS $ e OFFICE of the INSPECTOR of BUILDINGS Page_ Plot— �� APPLICATION FOR INSPECTOR ZONING PERMIT AND BUILDING PERMIT z IMPORTANT/- Applicant to complete all items in sections: 1, 11, 111, IV, and IX. O rlTi Q, ZONING I• AT (LOCATION) r r �X' DISTRICT LOCATION IN 0.) EET) OF BETWEEN .� ""Q AND BUILDING (CROSS STREET) (CROSS STREET) LOT SUBDIVISION LOT BLOCK SIIZE�d�fpQ iA II. TYPE AND COST OF BUILDING — All applicants complete Parts A — D A. TYPE OF IMPROVEMENT D. PROPOSED USE - For"Wrecking" most recent use rn rn 1 New building R i ntial Nonresidential 2 Addition(1 residential, enter number 12 L 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 3 Alteration (See 2 above) number of units- - -- -� 20 Industrial � _ 14 Transient hotel, motel, 21 Parking garage 4 Repair, replacement or dormitory - Enter number 5 Wrecking (If multifamily residential, of amts ------- -- 22 Service station, repair garage enter number of units in building in 15 Garage 23 Hospital, institutional Part D, 13) r-- -1 16 Carport 24 �� Office, bank, professional 6 _ j Moving (relocation) ,,� l 17 [l�] Other - Specify)&c�/, 25 r ] Public utility 7 ( Foundation only 26 �] School, library, other educational B. OWNERSHIP 27 �L Stores, mercantile 8 ] Private (individual, corporation, 28 �_� Tanks, towers nonprofit institution, etc.) 29 Other - Specify- 9 C:j 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•,,,•,•,•,•••,•, 4 o c- school, secondary school, college, parochial school, parking garage for department store, rental office building office building at industrial plant. 7o be installed but not included If use of existing building is being charged, enter proposed use. in the above cost a. Electrical....................... b. Plumbing ....................... �} c. Heating, air conditioning.......... d. Other (elevator, etc.)............. 11. TOTAL COST OF IMPROVEMENT is 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 private company 48. Number of stories................ Total square feet of floor area, 31 Wood frame 41 �� Private (septic tank, etc.) 49. _ all floors, based on exterior G 32 n 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 L_II Private (well, cistern) K. NUMBER OF OFF-STREET PARKING SPACES 51. Enclosed ....................... F. PRINCIPAL TYPE OF HEATING FUEL I. TYPE OF MECHANICAL 35 a Gas Will there be central air 52. Outdoors........................ 36 _1 Oil conditioning? L. RESIDENTIAL BUILDINGS ONLY 37 �j Elec'1M•wai.T. t ..,,...t._,. 44 � �'es 45 ! No 53. Number of bedrooms.............. a 38 n Coal 39 Other - Specify Will there be an elevators �.� Full.......... - _ 54. Nuber of 46 Yes 47 D No bathrooms Partial........ � __ �'z Y� DEPT. 8F BUILDING INSPECTIONS BUILDING ZD L 212 Main Street o< Northampton, MA 01060 PERMIT 25A - 77 VALIDATION DATE Sept. 12� 19_$$_ PERMIT NO. APPLICANT Franri c I aRnca ADDRESS rja rnn' j W^ A,,P OwnPr (N0.) (.TREY T) (CONTR'S LICENSE) PERMIT TO (_1 STORY !Go! Shed NUMBER OF DWELLING UNITS T PE OF MPR VEMENT) N0. (PROPOSEO USE) / ,,M ZONING Iv AT (LOCATION) r� Midge Ave DISTRICT IIRB (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 to repla ce existing tool shed/,* X 12' AREA OR 48 sq. ft. 500.00 PE 10.00 VOLUME ESTIMATED COST F (CUBIC/>fO UARE FEET) Same as Applicant OWNER Saffle as Applieamt's B ADDRESS WHITE - FILE COPY . GREEN - FIELD COPY • CANARY - APPLICANT COPY • PINK - ASSESSORS COPY pONtp