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IV. IDENTIFICATION — To be completed by all applicants
Nome Mailing address — Number, street, city, and State ZIP co Tel No.
O wner or - _ R- cE 0106 -6a 1 la o
Lessee
Builders
2, License No.
Contractor
3.
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.
Sig ture o applicant Address Application date
DO 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
Date Permit or Approval Check Obta ned Number By Permit or Approval Chec Obttaitned 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
II. VALIDATION _ "• '
Building , r► FOR DEPARTMENT USE ONLY
Permit number
Building. ` Use Group
Permit issued 19
Building Fire Grading
Permit Fee $ ' Live Loading
Certificate of Occupancy $ Occupancy Load
Approved b
Drain Tile $ f% 10-1
Plan Review Fee $
TITLE
CITY OF NORTHAMPTON
� MASSACHUSETTS
OFFICE of the INSPECTOR of BUILDINGS
G
Page Plot �'� APPLICATION FOR
INSPECTOR ZONING PERMIT AND
BUILDING PERMIT
z
IMPORTANT — Applicant to complete all items in sections: I, 11, 111, IV, and IX. O
C j(^t�,;C > ,'� ZONING
I• AT (LOCATION) A ,AS-4 L Uh F&OReN�� DISTRICT
LOCATION �RQ N0'' rr (STREET) ^ Q r n y\c
OF BETWEEN U��c�o�..S l I�LJ CI AND {JC-
BUILDING (CROSS STREET) (CROSS STREET)
LOT
SUBDIVISION LOT BLOCK SIZE
V1
II. TYPE AND COST OF BUILDING — A11 applicants complete Parts A — D
A. TYPE OF IMPROVEMENT D. PROPOSED USE - For"Wrecking" most recent use M
m
1 ❑ New building Residential Nonresidential
2,0 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
number of units- - - - -o- 20❑ Industrial
3 ❑ Alteration (See 2 above)
14 ❑ Transient hotel, motel, 21 ❑ Parking garage
4❑ Repair, replacement or dormitory - Enter number
5❑ Wrecking (If 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 — 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
/( procossing plant, machine shop, laundry building at hospital, elementary
10. Cost of improvement,,,,,,,,,.•...,. (1 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 iT
a. Electrical..................... G�
b. Plumbing .................... ) l��
c. Heating, air conditioning.........
d. Other(elevator, etc.)............
11. TOTAL COST OF IMPROVEMENT $ G eOO
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 ) 48. Number of stories...............
y (wall bearing) 40 Public or private company
31 Wood frame 41 ❑ Private (septic tank, etc.) 49• Total square feet of floor area,
all floors, based on exterior
32❑ Structural steel dimensions ..................... IrO,
33 ❑ Reinforced concrete H. TYPE OF WATER SUPPLY
34 ❑ Other — Specify 42 X Public or private company 50. Total land area, sq. ft. ........... 76
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 ❑ Oil conditioning? L. RESIDENTIAL BUILDINGS ONLY
37 XJ) Electricity 44 ❑ Yes 45X No 53. Number of bedrooms.............. O
38 ❑ Coal
39❑ Other — Specify Will there be an elevators Full..........
54. Number of
46 ❑ Yes 47 X No bathrooms '
Partial........
DEPT. C BUILDING INSPECTIONS BUILDING
0° r �
212 Main Street I
Northampton, MA 01060 PERMIT
29 - 284 VALIDATION
DATE April 2, 19 86 PERMIT NO. 127
APPLICANT Richard F. LeBeau ADDRESS 12 Pencasal Dr., Florence
(NO.) (STREET) (CONTR'S LICENSE)
OF
Addition One FAmily DWELLR
PERMIT TO STORY
DWELLING NUMBER(_)
(TYPE Of IMPROVEMENT) NO. (PROPOSED USE)
ZONING
AT'(LOCATION)
12 Pencasal Drive, Florence DIISTR CT(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 an addition onto existing dwelling to be used for living space (Living room
and bathroom enlarged)
AREA OR 576 sq. ft. ESTIMATED COST .� 10 000.00 PERMIT � 230.40
VOLUME
(CUBIC/SQUARE FEET) �'�'"
OWNER Same as A '1
Applicant BUI ^ s
ADDRESS Same as pp scan BY
WHITE - FILE COPY . GREEN - FIELD COPY ■ CANARY - APPLICANT COPY ■ PINK - ASSESSORS COPY pjNT P