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DEPARTMENT OF BUILDING INSPECTIONS
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INSPECTOR 212 Main Street ' Municipal Building
Northampton, Mass. 01060
AS A HOMEOWNER I UNDERSTAND THAT I MAY APPLY FOR AND RECEIVE
A BUILDING PERMIT FOR A HOME OR ADDITION I INTEND TO LIVE IN.
I ALSO UNDERSTAND THAT I AM RESPONSIBLE FOR KNOWING THE STATE
BUILDING CODE AND ZONING ORDINANCE OF THE CITY OF NORTHAMPTON.
BEING A HOMEOWNER AND NOT A PROFESSIONAL CONTRACTOR IN NO WAY
ABSOLVES ME OF ANY RESPONSIBILITY TO INSURE THAT ALL FACETS
OF THE RULES AND REGULATIONS ARE COMPLIED WITH.
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VIII. ZONING PLAN EXAMINERS NOTES
DISTRICT
FRONT YARD
SIDE YARD SIDE YARD
REAR YARD
1 IX. SITE OR PLOT PLAN For Applicant Use
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NOTES and Data — (For department use)
IV. IDENTIFICATION — To be completed by all applicants
Name Mailing address — Number, street, city, and State ZIP code Tel. No.
1. E� 8A4NER M G-�duC u'E Al
Owner or '�/�S
Lessee KIM
,�—Z- �[ L��a(/J All j 3 � '-
2. ! C7/7�1 7 3 AV<e� -5 / Liicenser,No. -2S3
CQOSsaetoi
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 B Date Plans By Notes
Fee Started y Approved
BUILDING $
PLUMBING $
MECHANICAL $
ELECTRICAL $
OTHER $
VI. ADDITIONAL PERMITS REQUIRED OR OTHER JURISDICTION APPROVALS
Date Permit or Approval Check Obtained Number By Permit or Approval Check Obttaatned 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 FOR DEPARTMENT USE ONLY
Permit number
Building r� _ Use Group
W
Permit issued lL9 k ( 19
Building Fire Grading
Permit Fee $
Live Loading
Certificate of Occupancy $ Occupancy Load
Approved by:
Drain Tile $ !
el
Plan Review Fee $
� r
T E
_ CITY OF NORTHAMPTON
�. MASSACHUSETTS
f OFFICE of the INSPECTOR of BUILDINGS
Page Plot APPLICATION FOR
ZONING PERMIT AND
INSPECTOR BUILDING PERMIT
z
IMPORTANT — Applicant to complete all VC in secc�t/ions: 1,, II, III, IV, and IX. 1 C1
�•' 0VI Vl.f ll-" EAi�� " 1VP ZONING
I• AT (LOCATION) � ,� DISTRICT
LOCATION /v(NO.) C (STREET) n /�/o`�
OF BETWEEN ` V �•'`�r\L L- W AND a� ,4p t
BUILDING (CROSS STREET) (CROSS STREET)
LOT
SUBDIVISION LOT BLOCK SIZE
N
11. TYPE AND COST OF BUILDING — All applicants complete Parts A — D ;0
A. TYPE OF IMPROVEMENT D. PROPOSED USE — For"Wrecking" most recent use M
m
I ❑ New building Residential Nonresidential
2 Addition(1 residential, enter number
� 12 One family 18 Amusement, recreational
i� of new housing units added, if any,
p�,C-(` in Part D, 13) 13 ❑� Two or more family - Enter 19 C❑ Church, other religious
number of units— — — — --)P- 20 Industrial
3 ❑ Alteration (See 2 above)
14 ❑ Transient hotel, motel, 21 Parking garage
4 ❑ Repair, replacement or dormitory — Fnter number
5 ❑ Wrecking (If multifamily residential, of units ——————— — -i 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) t
17 [::] Other - Specify ` 25 L❑ Public utility
7 ❑ Foundation only
26 ❑ School, library, other educational
B. OWNERSHIP /ZE C/�M T1 a A.1 A 4- 27 ❑ Stores, mercantile
8rivate (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
3 rte` processing plant, machine shop, laundry building at hospital, elementary
10. Cost of improvement... ........... Vv 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 $
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..............
31 'Wood frame 41 ❑ 49. Total square feet of floor area,
Private (septic tank, etc,)
all floors, based on exterior S;�
32 ❑ Structural steel dimensions .....................
33 ❑ Reinforced concrete H. TYPE OF WATER SUPPLY
34 ❑ Other — Specify 42 F—] 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 _V, No 53. Number of bedrooms..............
38 ❑ Coal
39 Other — Specify A10 C Will there be an elevator? Full..........
— 54. Number of
46 [-1 Yes 47 ' No bathrooms
Partial.......
DEPT. O�- BUILDING INSPECTIONS BUILDING z° ;
212 Main Street 0<
Northam t n MA 01060 PERMIT <a
VALIDATION
DATE
Mar. 29, 19 89 PERMIT NO. 180
APPLICANT Flan RarnPhama R Ni sa Zalta ADDRESS 77 Grove Ave. , Leeds
(NO.) (STREET) (CONTR'S LICENSE)
NUMBER OF
PERMIT TO Addit ion 1_1 STORY Deck DWELLING UNITS
(TYPE Of IMPROVEMENT) NO. (PROPOSED USE)
ZONING
AT (LOCATION)
77 OrnvP Ave Leeds DISTRICT----LIRA
(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
(TYP )
REMARKS, permit for the addition of a 550 sq. ft. deck onto rear of existing dwelling
AREA OR r 3000.00 PERMIT 10.00
$
VOLUME ESTIMATED COST FEE .$
(CUBIC/SQUARE FEET)
OWNER Same as Applicants - .-
Same as Applicants' BYILDING
ADDRESS .,i
WHITE - FILE COPY . GREEN - FIELD COPY ■ CANARY - APPLICANT COPY • PINK ^ ASSESSORS COPY P'iNf' P