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NOTES and Data — (For deportment use)
IV. IDENTIFICATION — To be completed by all applicants R
Name Mailing address — Number, street, city, and Stag ZIP code Tel. No.
Owner or f}A) l� I . t r � �
Lessee
Builder's �-
2. L ! >Te'A r-s ���' ��TH �, r� �� License No. J;O
Contractor r
3.
Architect or n
Engineer
I hereby certify that the proposed work is authorized by the owiner 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.
Signat* of applicant Address �^ Application date
. -� `b 5S
00 NOT WRITE E L 0 W 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 Obtained Number y Permit or Approval Check Date
ed 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
I
VII. VALIDATION
Building FOR DEPARTMENT USE ONLY
Permit number l
Bui Iding- Use Group
Permit issued 19
Buildin Fire Grading
9
Permit Fee $ `d� Live Loading
Certificate of Occupancy $ Occupancy Load
Appr d by:
Drain Tile $ '
Plan Review Fee $
i
TITLE
i
CITY OF NORTHAMPTON
�* • MASSACHUSETTS
$ OFFICE of the INSPECTOR of BUILDINGS
Page 17G Plot APPLICATION FOR
INSPECTOR ZONING PERMIT AND
BUILDING PERMIT
IMPORTANT — Applicant to complete all items in sections: 1, 11, III, IV, and IX. O
SI• AT (LOCATION) ZONING DISTRICT
LOCATION (NO.) (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 -f
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 fomily - Enter 19 ❑ 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 - Enter number
5 ❑ Wrecking (11 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 ❑J Office, bank, professional
6 ❑ Moving (relocation) p
17 ❑ Other - Specify 25 ❑ Public utility
7 C� Foundation only ��. \/"" '� 26 ❑ School, library, other educational
B. OWNERSHIP 27 �❑ Stores, mercantile
8 ® Private (individual, corporation, 2B ❑ Tanks, towers
nonprofit institution, etc.) 29 ❑ Other - Specify
9 ❑J 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•,•••••••••,•••• /90,040 — 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 Is laot)a
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 V.
�r
E. PRINCIPAL TYPE OF FRAME G. TYPE OF SEWAGE DISPOSAL J. DIMENSIONS
48. Number of stories......... /
30❑ Masonry (wall bearing) 40 Public or private company """ i/ 0 KZ t
31 Wood frame 41 Private (septic tank, etc.) 49. Total square feet floor area,
all floors, based on exterior ��� ,Q
32 Structural steel dimensions .
33 ❑ Reinforced concrete H. TYPE OF WATER SUPPLY
34 ❑ Other - Specify 42 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 IV Oil conditioning?
L. RESIDENTIAL BUILDINGS ONLY
37 ❑ Electricity 44 ❑J Yes 45 No 3
- 53. Number of bedrooms..............
38 ❑ Coo
39 L ] Other - Specify Will there be an elevator
Full.........
54. Number of
46 ] Yes 47Z No bathrooms Partial........
i
Department of Build4ng�Inspections BUILDING zp
212 Main Street oa
Northampton, Mass. 01060 PERMIT Qa (((.••����
VALIDATION
17C - 30.0
GATE May 4, 19 84 PERMIT NO. 179
APPLICANT Neil Homstead ADDRESS 408 No. Farms Rd 031244
(NO.) (STREET) (CONTR'S LICENSE{
Addition One Family Home NUMBER OF
PERMIT TO (_I STORY DWELLING UNITS _
(TYPE OF IMPROVEMENT) NO. (PROPOSED USE)
40 Lake St. ZONING UiB
AT (LOCATION) DISTRICT
(NO.) (STREET)
BETWEEN AND
(CROSS STREET) (CROSS STREET)
LOT
SUBDIVISION LOT BLOCK SIZE
Addtion
XXXXXX#XIS TO BE 14 FT. WIDE BY 28 FT. LONG BY FT. IN HEIGHT AND SHALL CONFORM IN CONSTRUCTION
TO TYPE USE GROUP BASEMENT WALLS OR FOUNDATION
(TYPE)
REMARKS, permlit for the construction of a family room and PXt deck
AREA VOLUME_ 392 sq. ft. ESTIMATED COST $ XXXONX 18,009EEMIT $ 72.00
(CUBIC/SQUARE FEET)
OWNER Dan Haugard
ADDRESS
40 Lake St. , Florence. Massa 01060 BYIL
WHITE - FILE COPY . GREEN - FIELD COPY . CANARY - APPLICANT COPY • PINK - ASSESSORS COPY