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NOTES and Data — (For department use)
IF
IV. IDENTIFICATION — To be completed by all applicants
Name Mailing address — A'umber, strcct, city, and Statc, ZIP code Tel. No.
1.
Owner or
Lessee
_ Builder's
1. License No.
Contractor Ali
7
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.
Signatrzz Iicant Address Application date
- 9
0 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
VI. ADDITIONAL PERMITS REQUIRED OR OTHER JURISDICTION APPROVALS
Dae 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 OZ
Permit number 7
Building c�� 19 .7,E
Permit issued
Building /� �
Permit Fee L
Certificate of Occupancy S
Approved by:
Drain Tile
Plan Review Fee _
TITLE
o� To
Crzty of Xox#4alnv#on - �
'MR5061c411setts
Office of tht �Ins}rrrtor of Ouilbings APPLICATION FOR
-�� Plot ZONING PERMIT AND
Page_ BUILDING PERMIT
IMPORTANT — Applicant to complete all items in sections: 1, 11, 111, IV, and IX. 0
ZONING
I• AT (LOCATION) '02 3 Z' Alm
// DISTRICT ,
LOCATION NO.) (STREET)
OF BETWEEN AND
BUILDING (CROSS STREET) (CROSS STREET)
LOT
SUBDIVISION LOT BLOCK SIZE co
II. TYPE AND COST OF BUILDING — All applicants complete Parts A — D m
A. TYPE OF IMPROVEMENT D. PROPOSED USE — For"Wrecking" most recent use M
--I
1 ❑ New building Residen al Nonresidential
2 ❑ Addition(If residential, enter number 12 One family 18 ❑ Amusement, recreational
i new housing units added, if any, 13 ❑ Two or more fami ly — Enter 19 ❑ Church, other religious
iryPati D, 13) —
u�/ 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 F-1 Wrecking (If 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❑ Office, bank, professional
6 ❑ Moving (relocation) 25❑ Public utility
17 ❑ Other — Specify
7 ❑ Foundation only 26 ❑ School, library, other educational
B. OWNE IP 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................ Y 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..................... s
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 IV. y
0
E. PRINCIPAL TYPE OF FRAME G. TYPE OF SEWAGE DISPOSAL J. DIMENSIONS m
48. Number of stories................
30❑Ma ry (wall bearing) 40 ❑ Public or private company ..
31 ood frame ❑ p 49. Total square feet of floor area,
41 Private (septic tank, etc.) all floors, based on exterior
32❑ Structural steel dimensions .....................
33❑ Reinforced concrete H. TYPE OF WATER SUPPLY
50. Total land area, sq. ft. ...........
34❑ 42 Other — Specify ❑ Public or private company
p y
43 ❑ Private (well, cistern) K. NUMBER OF OFF-STREET
PARKING SPACES
51. Enclosed ....................... r
F. PRINCIPAL TYPE OF HEATING FUEL I. TYPE OF MECHANICAL 0
35 ❑ Gas Will there be central air 52. Outdoors........................
36 ❑ Oil conditioning? L. RESIDENTIAL BUILDINGS ONLY
37 ❑ Electricity 44 ❑ Yes 45 ❑ No 53. Number of bedrooms..............
38 ❑ Cool
39 ❑ Other — Specify Will there be an elevator? 54. Number of Full..........
46 ❑ Yes 47 ❑ No bathrooms Partial........
I hereby certify that the proposed work is authorized by the owner of record
and I have been authorized by the owner to make this application 6s-,his
authorized agent.
SIGNATURE OF AGENT
ADDRESS ..,
(NUMBER) (STREET) (CITY)
APPROVED BY TITLE
DATE -19—
DEPT. FILE COPY
Z0
GTTY OF NORTHAMPTON BUILDING 2 a
NOR TIWOWNI, t'lie~a7y. PERMIT VALIDATION
25k - 157 ,,Q
DATE Septeaber 26* 19 77 PERMIT NO. 487
APPLICANT Charles-K. ei3agon ADDRESS ? North S+-TAB+
(NO. (STREET) (CONTR'S LICENSE)
NUMBER OF
PERMIT TO Alterations (_) STORY Residence DWELLING UN17S 1
(TYPE .OAF,IMPROVEMENT) NO. (PROPOSED USE)
ZONING
AT (LOCATION) 234 North DISTRICT Un
(NO.) (STREET)
a BETWEEN AND
(CROSS STREET) (CROSS STREET)
a
LOT
IL
m SUBDIVISION LOT BLOCK SIZE
a
U
O BUILDING IS TO BE FT. WIDE BY FT. LONG BY FT. IN HEIGHT AND SHALL CONFORM IN CONSTRUCTION
M
O
Z TO TYPE USE GROUP BASEMENT WALLS OR FOUNDATION
F (TYPE)
It
LL REMARKS: Remove inta3:jQr Nall I=Iace iindom
AREA OR
VOLUME ESTIMATED COST $ 2250.00 FEEMIT $ 10.00
(CUBIC/SQUARE FEET)
OWNER Charles A Vereniea DXa"n
BUILO2DEtA
ADDRESS 234 North ^Street. Nn cn BY
(Affidavit on reverse side of application to be completed by ou gent of owner)