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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.
Owner or
Lessee
Builder's
2. License No.
Contractor
s.
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
A-l' �ln
00 NOT WRITE BELOW THIS LINE
V. PLAN REVIEW R CORD — For office use
Plans Review Required Check Plan Review Date Plans B Date Plans B Notes
q Fee Started y Approved y
BUILDING $
PLUMBING $
MECHANICAL $
ELECTRICAL $
OTHER is
VI. ADDITIONAL PERMITS REQUIRED OR OTHER JURISDICTION APPROVALS
Permit or Approval Check Date Number By Permit or Approval Check Date Number B
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
VII. VALIDATION
Building ` FOR DEPARTMENT USE ONLY
Permit number `dry
Building Use Group
Permit issued C 19
Building l Fire Grading
Permit Fee $ x V Live Loading
Certificate of Occupancy $ Occupancy Load
Ap by:
Drain Tile $ 14C_4�
Plan Review Fee $
TITLE
CITY OF NORTHAMPTON
MASSACHUSETTS
r •
g e OFFICE of the INSPECTOR of BUILDINGS
�t Page !? G Plot Iry APPLICATION FOR
ZONING PERMIT AND
INSPECTOR BUILDING PERMIT
z
IMPORTANT — Applicant to complete all items in sections: 1, 11, 111, IV, and IX. 0
I•
ZONING
AT (LOCATION)�/ R
,.5 � I/�
DISTRICT
LOCATION N/1) (STREET)
OF BETWEEN AND
BUILDING (CROSS STREET) (CROSS STREET)
LOT
SUBDIVISION LOT BLOCK SIZE
Vr
II. TYPE AND COST OF BUILDING — All applicants complete Parts A — D
A. TYPE OF IMPROVEMENT D. PROPOSED USE — For"Wrecking" most recent use m
m
1 ❑ New building Residential Nonresidential
2 ❑ Addition(If residential, enter number 12 ❑ One 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
3 Alteration (See 2 above)
number of units- - - - -� 20 ❑ Industrial
❑
14 ❑ Transient hotel, motel, 21 C� Parking garage
4 ❑ Repair, replacement or dormitory - Enter number
5 ❑ Wrecking (1l 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) 17 ❑� Other - Specify /j/�lylrt.1/'� 25 ❑ Public utility
7 Foundation only
&,06 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
L processing plant, machine shop, laundry building of hospital, elementary
10. Cost of improvement•,••••••,....... o 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 [❑ Private (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 F-1 Public or private company 50. Total lord 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........................ L
36 ❑ Oil conditioning? L. RESIDENTIAL BUILDINGS ONLY
37 Cf Electricity 44 Yes 451 No
53. Number of bedrooms..............
38 ❑ Coal
39 ❑ Other - Specify Will there be an elevator? Full..........
- 54. Number of
46 Yes 47 ❑ No bathrooms
- Partial.......
a DEPT. OF'SUILDING INSPECTIONS BUILDING z°- 4 aCtC
a 212 Main Street 0<
Northampton, MA 01060 PERMIT
17C - 160 p VALIDATION
DATE July 25, 19 86 PERMIT NO. 425
APPLICANT .3maps F RnglP ADDRESS 266 West Farms Road On vile
(NO.) (STREET) (CONTR'S LICENSE)
NUMBER OF
PERMIT TO Gnllnriatinn Only( ► STORY Res/Bus. — DWELLING UNITS
(TYPE OF MPR OVEMENT) N0. (PROPOSED USE)
ZONING GB
AT (LOCATION) eyes ree DISTRICT
(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 for the construction of foundation only for proposed mixed Tres/bus
---Fu TIM ing
AREA OR 1200 sq. ft. ESTIMATED COST $ 5-00m 0 PER .� 20.00
VOLUME
(CUBIC/SQUARE FEET)
OWNER BUILDI T
ADDRESS I BY
WHITE - FILE COPY . GREEN - FIELD COPY • CANARY ^ APPLICANT COPY • PINK - ASSESSORS COPY p 0-f -P