29-124 (5) /jx 4
For ALL buildings within Fire District and for other buildings costing $10,000.00 or more, plans
and specifications must be submitted to the Inspector of Buildings for examination and approval.
If building is to be moved give details relative to proposed location as for a new building.
Application for Permit to Build
Northampton, Mass. » ».....1.».:......1e .:..
To the Inspector of Buildings:—
The undersigned hereby applies for a permit to build, move, alter, or repair, according to the
following specifications.—
1".t -i �,.... f- ' ............t�...la::r:,Y ....................
1. Owner's name ... ...,..... .�.......... .......». ......... ......... ..................».............».......».......»........
2. Owner's address . . ..».. '»:»........ ..........................».»....»....».»............._.............»............................»....».................................
3. Architect's name ...:1:.. .... » :.......................... ..........................»....»......................_......................................................................................
4. Builder's name .....,.r`...l r :. .........»....».... .......................»............................_.........................»..........................................................
5. Builder's address ..... ..........r .;.:.:.......... :.»..:.. .......». . .... . ..................................................................................................
6. Location of Building. Street No. .....��r.: .. r'r' :��, ..! s ...........».................................................
7. Is this a removal or new building.....!: .:.... .::...:.....:». ;......: .....................................................................
8. If removal, from where ............................»........................................................,...................................................................»...................
9. What is the purpose of building ..... .f: ::...... r.t............................................................................................................................
10. Material of building .... :......ti...............».......»......................................................................»............................».........................................
11. If a dwelling, for how many families ........................................».....Number of rooms ...................................................
12. Is there to be a store in the building .....�l ...........
13. Size of building, No. of feet front .»C ::»....».....;No. of feet deep ... ......; No. of stories ...., ....»....»..
14. Size of ell, No. of feet front .... °:........; No. of feet deep » ::........; No. of feet high �......» ..
........... ......
15. Size of Lot ............`.. :»...........................................................Feet Wide ..,/..... ... ................. Feet Deep .................................
16. How near the-line of street ............2..:::......: .............................................................................».........................»...............................
17. How near the line adjoining lot. Right ; L eft ..............
,
Rear......'`...::...»..............
18. Nearest building is ................................. feet in a...................................................... direction .....................................................
19. Material of the floor .................. .................................................................................................................................................
20. Size of timbers, 1st .'........»....»....; 2nd ....................... : 3rd .......................; 4th .................»..........; 5th ............................
21. No. of feet span • Distance on centers_ .......:» ....... .�.
22. Will the building be erected on solid or filled land ...........' :............»........ . ............................................................. ..
23. What is the material of foundation ............ ` .... `....».......»....»....».................................; Footing .......................
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24. Will the roof be flat or pitcbe ,'»...: .�'t ....; Covering.....:!.> �'.�:'... ;.... »
25. Heat; steam, hot water, furnace, stoves... ': ::: ...................: Power oil burner
26. Fireplace .... k ....:::... ...........................................: Insulation ..............»..............................................................................................
27. How many sinks ,'......fir; Toilets ...........; Lavatories ........; Bathtubs.....»..; Showers............: Settubs
28. City Service; Water .: ::................ Sewer ........................: Road Surface ..........................; Sidewalk ........................
29. Is lot on accepted street ............................................»............................................................................................................................
30. Estimated cost (must be filled out) ...: k:.s:....»...................».......»..............................................»....».........................................
Applicant agrees to give the Inspector of Buildings 24 hours' notice before lathing or
plastering this building. This building will copfo-nm to the requirements of the law.
Signatureof applicant ........ .... .......:.... ..».`.»»..»..........»...................» ....................................................................
REMARKS
:
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............................................................».............»....».»......................................................».............................................................».......».......»...............................
............»...........»......».............»....»..........».......».......»................».......».......................................................................................................................................................
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ZONING PERMIT
APPLICATION
Telephone Telcphoiic.
This section is to be fill(-,1 out in ocrordruoo �iUh U�e »y Dioouo1vor1 and
Density Regulatiolle: . (Z A!,'T1C1J,' W.
Propoced
rrecent
Mork the opProDrixte 1,ox to iodiocte the usr of t}i' Prrnpl:
F--�
Non-:CooforminC Ict ,od/or Structura. SI`eolfy°____-------- ----------- --------
' ---- ---- - --- -'------- '--- -------''
Residential i���� r
inCIo � n tL_�
i]� Vui1'ulti-FnmdIJ
[--lDnullmx F--lOtbal
F--lDuo1oena
F--1
Industrial
Iootitutin-~]
[--1
Subdivision [--1 �e-u] ,r �—� P.D.D^
----
[--l8ubd1vio1nu with n���rovxl-�nt-R'?:i,vd"-Stom�:
F--lPlanning Tlonrd Ap}'r»vxI:
= Qoniva Board Approval (Dyooinl Peq,a-jt I0^�: Vico)
= city Council (Special F ti )
ED
This ncct1uo for OFFICIAL u�o only:
rovnI no presented:
=Hod1Cinotinun orcoscrr� Iur ,T)j)rnrnl:
F--]Betoro: (More ioiormnti"u ocpdcd\
F--lDeoioI: Brnrono:
I hereby certify that the proposed work is authorized_lby:the owner of record
and 1 have been authorized by the owner to-make'this application` as`'his `
authorized agent.
SIGNATURE Or--GENT
ADDRESS
.(NUMBER) (STREET) (Cl 7Y)
v
APPROVED BY TITLE
DATE 19
DEPT. FILE COPY
_ Z in
City of Northampton fa
Massachusetts BUILDING
Office of the Inspector of Buildings PERMIT VALIDATION
DATE
< RMIT N
ADDREAPPLICANT N0 ST
(CONT R'S IICE.N SE)
NUMBER OF
PERMIT TO (_) STORY DWELLING UNITS
'it
(TYPE OF MPROVEMENT) N0. (PROPOSED USE)
ZONING
AT (LOCATION) 432 DISTRICT
(NO.) V (STREET)
a BETWEEN AND
�o (CROSS STREET) (CROSS STREET)
m
LOT
m
SUBDIVISION LOT BLOCK SIZE
N
O BUILDING IS TO BE • FT. WIDE BY FT. LONG BY FT. IN HEIGHT AND SHALL CONFORM IN CONSTRUCTION
O
m
Z TO TYPE USE GROUP BASEMENT WALLS OR FOUNDATION
(TYPE)
I
Ir
O
LL REMARKS:
AREA OR (/0 $ (Q FEE MIT `Q r Q�
VOLUME ESTIMATED COST
(CUBIC/SQUARE FEET)
OWNER BUILDI
ADDRES BY
(Affidavit on reverse side of application to be completed by authorize agent of owner)
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