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DRAWN BY DATE
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REVISED DATE SCALE EIIE NUMNA
SOUTH HIV BRIDGE CI11ICLE AGAWAM, MASSACHUSETTS 01001 1413) 734•25PO 3;1,764
MEMOCAS OF AMERICAN INSTITUfl Or, KITCHEN EN DEALEAS
For ALL buildings within Fire District and for other buildings costing$10,000.00 or more,plans
and specifications must be submitted to the Inspector of Buildings for examination and approval.
If building is to be moved give details relative to proposed location as for a new building.
.Application for Permit to Build.
Northampton, Mass., ....Z„. .... 7.„.. —„ 19„.x .
To the Inspector of Buildings:—
The undersigned hereby applies for a permit to build, move, alter, or repair, according to the
following specifications.-
1. Owner's name
2. Owner's address
3. Architect's name,../.......„....„... „...._.....„„....».„.„..„........................................... ...„„„.„.„.............„............._..„„„„. _„. .. „... .„„.
4. Builder's name .......
�` „e,r .N._„
5. Builder's address .sa�.:T�l.... t.�a.� .lr.�.f .�::p......
.►..t ..�.,.�.. ..„.„„.„.„ „ .tP-.wt...�--.„„„„„.„. .
6. Location of Building. Street No.
7. Is this a removal or new building ...„...... ...„...........................„..............„..........„»....„„.»
8. If removal, from where .....„..„„.„.......»...„.„.......„..............„............................„..„....„.„„.................................
„...„„.„...„„„»....„.
9. What is the purpose of building ...............................„...............................„......„.......„.......„........„...„....
..
10. Material of building .....................„.......„.„.............................„..............„...„...... .. „.......„..„....„.„... ...„..»„„„.„.„.„......„.....»
11. If a dwelling, for how many families..........................................Number of rooms ....„................».„ ..„„.„...„..„
12. Is there to be a store in the building »...„..„............„„..„......._.._„ ..„„....„....._.„.....„......„...._....„„„. _..„ _. „.....
13. Size of building, No. of feet front „„.»...._...._...;No. of feet deep „.„»„...„.........; No. of stories.„„„.........„
14. Size of ell, No. of feet front ...... ..„...........; No. of feet deep ...„.... ....„„„.; No. of feet high „. »..„...
15. Size of Lot .............»....„w....„......»....»...._.„.._.„....„....„......»Feet Wide »..„..»..„„„.„..„„ . Feet Deep
16. How near the-line of street ..............„.......„....„........._.„.„..........„. ..„.....„.......„.„. .„„ .„.
17. How near the line adjoining lot. Right„...............».» ...„„„..; Left„ „ .„„...... .„.._.„; Rear.......„..„.. . „... ...
18. Nearest building is ...................„..„.......feet in a.............................„..... ...»... direction ..„......................»„„....„ .. .„„
19. Material of the floor ..„.»............................_.»......„....„.„.„„„.» „....„...„._...„.....„....„„„.._„...„„...„.._„..„. .......„.....„ .„._..._„„...„
20. Size of timbers, 1st...». ......»...„; 2nd .....„...._..„„... ; 3rd ......... ....„.. .; 4th ..„„..„ .„» .„ ..; 5th „„ .„......_...._..»
21. No. of feet span.„...„.„.»......„....„.......„....„.......„..„_....„„.... ; Distance on centers ..._.„....„......„.....„....„„„..„„...» „....�.
22. Will the building be erected on solid or filled land .....„.„....„..„ „.._.„...„.,..„.......„..„„..........„.........
»„„....„..„..„„...
23. What is the material of foundation.„„»„„,.». ..„.„......„....„....„ .»»..„»....„„...„....»„..„ .; Footing ..._...„....„.....
24. Will the roof be flat or pitched ...„„...„ ... „.„..„.........„...„.....».....„.; Covering.....„.„.„....„».................„„„»
25. Heat; steam, hot water, furnace, stoves „...„.„....... ... ....„.....„.. ; Power oil burner.....„......„..„ „. »... .....
26. Fireplace „..„„.„......._.„..........»„......; Insulation ........„....„..„....„. ..„... ..„..„.......„.....„.„„....„„....„„„.„_„.„„...„.„
27. How many sinks .........„.; Toilets ...........; Lavatories __; Bathtubs.„......; Showers....._.....; Settubs
28. City Service; Water .....»....„....»..... Sewer ...........»...„......; Road Surface .„..„„.....„...„„...; Sidewalk
29. Is lot on accepted street „......_....„....„.„....»...„......................„.......„„.„....„.„......„.......................„....„....»...„...„..„.....„..„....„».. ......„
30. Estimated cost (must be filled out) .- ._. Gp'.U�
Applicant agrees to give the Inspector of Buildings 24 hours' notice before lathing or
plastering this building. This building will conform to the requirements of the law.
Signature of a PP licant L„ ................
......... „. '� »„.„.. „„�„...»...„. ,„.„„...„».......„..„_..„ „„ ..„_......„.....
No...............
REMARKS ` f
.........».. .. ...`.:`_'e::„ ............................ .....!...J...... .................. .. ..
�y...„'.........................„................„.........._...............„......._......._....„._.......„._ .»....„ ....„.„.....
h
I hereby certify that the proposed work is authorized by the owner of record
and I have been authorized by the owner to m ke this application as his
authorized agent.
SIGNATURE OF AGENT
ADDRESS
(NUMBE.R) (STREET) (CITY) -
APPROVED BY TITLE
DATE 19
DEPT. FILE COPY
ZO
:3-
BUILDING
PERMIT
° VALIDATION
DATE u`' i19_7MPERMIT NO 938
APPLICANT 4Jgai'v 'Rj ADDRESS T 40041w dA-\
_
(NO.) (STREET) (CONTR'S LICENSE)
�� NUMBER OF /
PERMIT TO 1kL �ATi�� (_) STORY DWELLING UNITS
(TYPE OF IMPROVEMENT) NO.NO. ry� (PROPOSED USE))
AT (LOCATION) V" /&W'r &,e), "e Mass ZONING
(N0.) (STREET) DISTR ICT
a BETWEEN AND
a
(CROSS STREET) (CROSS STREET)
n O
SUBDIVISION LOT BLOCK SIZE
m
a
U
0 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
� T7, f�_, `. , y��` �± (TYPE)
LL REMARKS: L&1219 e 1 yPY>4_ CeiL^j/�0W zVf+�QrL
AREA OR
VOLUME ESTIMATED COST $ FEE MIT �'U�
(CUBIC/SQUARE FEET)
OWNER (/�+-M -r-T
ADDRESS 2 � ��`� +P"m-c_ BUILDING DEPT�yJ__,
BY �LG/
(Affidavit on reverse side of application to be completed by authorized agent of owner)