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' DEPARTMENT OF BUILDING INSPECTIONS ?
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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SIDE YARD SIDE YARD
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OR PLOT
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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.
I / U/3PkT ^7171EAIZ4
Owner or TCV1V4 :5(-//gCGH 57—.
Lessee �(!j 7/
Builder's
2. `/rt11rl e 6- ove License No.
Contractor
3.
Architect or Nnlyie
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 Appl'coti n date
t
DO NOT WRITE BELOW THIS LINE
V. PLAN REVIEW RECORD — For office use
Plans Review Required Check Plan Review Date plans B Date Plans B Notes
9 Fee Started y Approved y
BUILDING $
PLUMBING $
MECHANICAL $
ELECTRICAL $
OTHER $
VI. ADDITIONAL PERMITS REQUIRED OR OTHER JURISDICTION APPROVALS
Permit or Approval Check Obttatn d Number By Permit or Approval Check obtained 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 1 Use Group
Permit issued ` � 19 (3 1
Building �— Fire Grading
Permit Fee $ Q)� DO Live Loading
Certificate of Occupancy $ occupancy Load
Approved by:
Drain Tile $ �,
Plan Review Fee $
TITLE
CITY OF NORTHAMPTON
�• MASSACHUSETTS
OFFICE of the INSPECTOR of BUILDINGS
Page c; 2 Plot APPLICATION FOR
INSPECTOR ZONING PERMIT AND
BUILDING PERMIT
IMPORTANT — Applicant to complete all items in sections: 1, 11, 111, IV, and IX. O
" Sry'' ZONING
/
I• AT (LOCATION) /-� � '/ � '1 /'` Y "' / DISTRICT UVIE
LOCATION (NO.) C (STRE T)
OF BETWEEN ` /6YI V 74 AND /1/,1'el G oo -Tee
'
BUILDING (CROSS STREET) (CROSS STREET)
LOT
SUBDIVISION LOT BLOCK SIZE
V1
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
i New building Resid tial Nonresidential
2 Addition(If residential, enter number 12 One family 18 Amusement, recreational
of neu, housing units added, if any,
in Part D, 13) 13 Two or more family — Enter 19 n Church, other religious
3 Alteration (.See 2 above) number of units— — — — > 20 Fr � Industrial
14 �� Transient hotel, motel, 21 l Parking garage
4 Repair, replacement or dormitory — Enter number
5 �_ Wrecking (If 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 �� �I Office, bank, professional
6 Moving (relocation)
7 E] Foundation only 17 Other — Specify 25 I Public utility
26 F] School, library, other educational
B. OWNERSHIP 27 Stores, mercantile
B VPrivate (individual, corporation,
28 n Tanks, towers
nonprofit institution, etc.) 29 Other — Specify
9 D Public (Federal, State, or
local government)
C. COST (Omit�t Nonresidential — Describe in detail proposed use of buildings, e.g., food
processing plant, machine shop, laundry building at hospital, elementary
10. Cost of improvement,,,,,,,•,,•,,,,, 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 chai.ged, enter proposed use.
in the above cost
a. Electrical....................... CJ C✓
b. Plumbing ....................... v
c. Heating, air conditioning..........
d. Other (elevator, etc.).............
11. TOTAL COST OF IMPROVEMENT $ .�"CiGCi
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 F SEWAGE DISPOSAL J. DIMENSIONS
30 asonry (wall bearing) 40 Public or private company 48. Number of stories................
31 Wood frame 41 n Private (septic tank, etc.) 49. Total square feet of floor area, TO
all floors, based on exterior
32 Structural steel dimensions .....................
33 Reinforced concrete H. TYP OF WATER SUPPLY
34 � Other — .Specify 42 a Public or private company
50. Total land ores, sq. ft. ........... J
43 ❑ Private (well, cistern) K. NUMBER OF OFF-STREET
PARKING SPACES
F. PRINCIPAL TYPE OF HEATING FUEL I. TYPE OF MECHANICAL 51. Enclosed .......................
35 Eas Will there be central air 52. Outdoors........................
36 Oil conditioning?
L. RESIDENTIAL BUILDINGS ONLY
37 Electricity 44 n Yes 45 VrNo 53. Number of bedrooms..............
38 Coal
39 Other — Specify Will there be an elevators Full..........tl 54. Number of
46 [_1 Yes 47 '� No bathrooms Partial........ /
DEPT. OF BUILDING Street BUILDING oa
Northampton, MA 01060 PERMIT
23D - 101 p VALIDATION
DATE M&V 1 F; 19 Rg PERMIT NO. 321
APPLICANT Robor+ Maion7a R. .lnnna Cr fjlDDRESS 136 WiAj j.@ St. DnPr�_
(lNOO. ° sT E ) (CONTR'S LICENSE)
NUMBER OF
PERMIT TO 1_) STORY DWELLING UNITS
q#. NO. (P SE
ZONING ''I7
AT (LOCATION) DISTRICT U&R
(NO.) (lTRE
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
Two (TYPE)
REMARKS, permit for a XH story addition open up existing room and add bathroom
AREA OR 45 sq. ft. 2nd fl .& 35 sq. ft. 1st. fl . 5PLDIONGU 00.0 0 DEPT. pER T 23.00
VOLUME ESTIMATED COST(CUBIC/SQUARE FEET)
OWNER Same as Applicants
ADDRESS Same aS Appl lCdntS( B BY
WHITE - FILE COPY . GREEN - FIELD COPY • CANARY - APPLICANT COPY • PINK - ASSESSORS COPY omp