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NOTES and Data — (For department use)
XZJ22
IV. IDENTIFICATION — To be completed by all applicants
Name Mailing ad//dress — Number, street, city, and State ZIP code Tel. No.
Owner or
Lessee
/_ jBuilder's
2. (�/, %/ �� 1 License No.
Contractor IF
3. 2
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 Addr 5s Applicqtion d to
00 NOT WRITE BELOW THIS LINE
V ' PLAN REVIEW RECORD — For office use
Plans Review Required Check Plan Review Date Plans By Date Plans By Notes
Fee Started Approved
BUILDING $
PLUMBING $
MECHANICAL $
ELECTRICAL $
OTHER $
VI. ADDITIONAL PERMITS REQUIRED OR OTHER JURISDICTION APPROVALS
Permit or Approval Check Dote Number By Permit or Approval Check Date Number 8
Obtained Obtained 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
II. VALIDATION
Building - FOR DEPARTMENT USE ONLY
Permit number
Building. f Use Group
Permit issued / 19
Building ,�l Fire Grading
Permit Fee $ /J =� Live Loading
Certificate of Occupancy Occupancy Load
Ap ve by: f�
Drain Tile
Plan Review Fee $
TITLE
°t Y
CITY OF NORTHAMPTON
�. MASSACHUSETTS Iy
A
OFFICE of the INSPECTOR of BUILDINGS - -
Page ZA Plot 2-t-3 I APP C TI ON FOR
INSPECTOR ZONING PERMIT AND
BUILDING PERMIT
z
IMPORTANT — Applicant to complete all items in sections: 1, 11, 111, IV, and IX. O
ZONIN
I. � ! /1 G DISTRV
AT (LOCATION)
LOCATION (NO.) (STREET)
OF BETWEEN AND
BUILDING (CROSS STREET) (CROSS STREET)
LOT
SUBDIVISION LOT BLOCK SIZE
N
II. TYPE AND COST OF BUILDING — A11 applicants complete Parts A — D M
A. TYPE OF IMPROVEMENT D. PROPOSED USE — For"Wrecking" most recent use rn
rn
1 ❑ New building Residential Nonresidential
2 XAddition((/ residential, enter number 12`�rOne family 18 ❑ Amusement, recreational
of new housing units added, if any, +
in Part D, 13) 13 ❑ Two or more family — Enter 19 ❑ Church, other religious
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 ❑ Wrecking (11 multi family 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)
17❑ Other — Speci/y 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,,,,,,,,,,,,,,,, C_TC770 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..................... CGS
b. Plumbing ..................... 4`07Di
c. Heating, air conditioning.........
d. Other(elevator, etc.)............ �7
11. TOTAL COST OF IMPROVEMENT Y /
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�Privote (septic tank, etc.) 49• Total square feet of floor area,
all floors, based on exterior
32 ❑ Structural steel dimensions .....................
33❑ Reinforced concrete H. TYPE,,��/�OF WATER SUPPLY
34 F-1 Other — Specify 42 blic or private company 50. Total land area, sq. ft. ...........
481n Private(well, cistern) K. NUMBER OF OFF-STREET
PARKING SPACES
F. PRINCIPAL TYPE OF HEATING FUEL 1. TYPE OF MECHANICAL 51. Enclosed ......................
35 ❑ Gas Will there be central air 52. Outdoors........................
36 Se Oil conditioning?
L. RESIDENTIAL BUILDINGS ONLY
37 Electricity 44 n Yes 451 No 53. Number of bedrooms..............
38 �� Coal ��ss
39 n Other — Specify Will there be an elevator? Full..........
54. Number of
46 ❑ Yes 47 I�Q No bathrooms
�>--, Partial.......
Department of Building Inspections
212 Main Street
Northampton, Mass: X1060 BUILDING o° $48.00
17A - 231 PERMIT
VALIDATION
DATE September 18, )g 84 P RMIT NO. 427
APPLICANT
G.W. Tibb6tts ADDRESS P• ox 15 , Florence
(N0.) (STREET) (t ONT R'S LICENSE)
NUMBER OF
PERMIT TO Addition (_) STORY One Family Home DWELLING UNITS -
(TYPE OF IMPROVEMENT) NO. (PROPOSED USE)
97 Lake Street ZONING URB
AT (LOCATION) 01STRICT
(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 construct an addition
AREA OR 1,x}00. sq. ft. ESTIMATED COST � 17,000.00 FEE MIT .� 48.00
VOLUME
(CUBIC/SQUARE FEET) �..�
OWNER Mark O'Connell '
ADDRESS 97 Lake Street, Florence, Mass. 01060 BY
IL
WHITE - FILE COPY . GREEN - FIELD COPY ■ CANARY • APPLICANT COPY PIN - ASSESSORS COPY