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DISTRICT
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NOTES and Data — (For department use)
IV. IDENTIFICATION — To be completed by all applicants
Name Mailing address — Number, street, city, anri State ZIP code Tel. No.
JPN
Owner or
Lessee
" Bui Iderrs
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.
Signature of applicant Address Application ate
00 NOT WRITE BELOW THIS LINE
V. PLAN REVIEW RECORD — For office use
Plans Review Required Check Plan Review Date Plans By y
Date Plans B Notes
9 Fee Started Approved
BUILDING $
PLUMBING $
MECHANICAL $
ELECTRICAL $
OTHER
VI. ADDITIONAL PERMITS REQUIRED OR OTHER JURISDICTION APPROVALS
Date Date
Permit or Approval Check Obtained 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 L)
Building Use Group
Permit issued %� Llyu
19
Building / � Fire Grading
Permit Fee Iv1
Live Loading
Certificate of Occupancy $ Occupana Load
rQ1V d by:
Drain Tile $
Plan Review Fee $
TITLE
CITY OF NORTHAMPTON
MASSACHUSETTS
OFFICE of the INSPECTOR of BULLDINGS
Page _ Plot APPLICATION FOR
ZONING PERMIT AND
INSPECTOR BUILDING PERMIT
IMPORTANT — Applicant to complete all items in sections: 1, 11, 111, IV, and IX. O
I•
ZONING
AT (LOCATION) / �
DISTRI T
LOCATION (NO.) (STREET)
OF BETWEEN AND
BUILDING (CROSS STREET) (CROSS STREET)
LOT
SUBDIVISION LOT BLOCK SIZE
N
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
--f
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
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 L❑ Private (individual, corporation, �[l�l 28 ❑ Tanks, towers
nonprofit institution, etc.) 29 L❑ Other — Specify
9 ❑ 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,.••.••.,•,.•.., i D 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 $ wz)
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 L 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 ❑ Other — Specify 42 ❑ Public or private company 50. Total land area, sq. 4t. ..........
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 �� Electricity 44 ❑ Yes 45 �7 No 53. Number of bedrooms..............
38 ❑ Coal
39 Other — Specify Will there be an elevator? Number of
E] 54. Nuber of
46 [-1 Yes 47 No bathrooms
— Partial.......
Department of-` 'ag Inspections
212 Main Street BUILD 1 NG
Northampton, Masi;. 01060 ;�
PERMIT $10.00
35 -. 202 VALIDATION
DATE Jane 28, (g 84 PERMIT NO. 270
APPLICANT Teddy Bear Pools ADDRESS icopee,Mass.
(NO.) (STREET) (CONTR'S LICENSE)
Addition Above Ground Pool NUMBER OF _
PERMIT TO 1_I STORY DWELLING UNITS
(TYPE OF IMPROVEMENT) N0. (PROPOSED USE)
ZONING
AT (LOCATION)
1292 Burts Pit Road DISTRICT AT
(N0.) (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. pelt for the installation of a above ground pool in the rear of existing home
AREA OR 2 000.00 FEEMtT 10.00 VOLUME ESTIMATED COST +
(CUBIC/SQUARE FEET)
Gerald & Susan Hague
OWNER BUILD
ADDRESS 1292 Burt:s Pit Road, Florence, Mass. 01060
WHITE - FILE COPY ■ GREEN - FIELD COPY ■ CANARY - APPLICANT COPY PINK - SSESSORS COPY