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REAR YARD
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NOTES and Data — (For department use)
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Qllf� of wort 1jamptall
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DEPARTMENT OF BUILDING INSPECTIONS
INSPECTOR 212 Main Street ' Municipal Building •'
Northampton, Mass. 01060 v,
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 HOMEOWJNER 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.
IV. IDENTIFICATION — To be completed by all applicants
ame Mailing ess — Num er, stmt, city, and State ZIP code Tel. No.
Owner or
Lessee
Builder's
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 ve been authorized by the owner to
ake
m is application as autho d agent nd we ogre t c rm to appfi ab ws this jurisdiction.
na a li a t Add es J is lion at
c
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
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
Building _ Use Group
Permit issued �� ' 3 �� 19
Building Fire Grading
rQ J
Permit Fee $
Live Loading
Certificate of Occupancy $ Occupancy Load
Approved by:
Drain Tile $ ~
Plan Review Fee $ "�` n
,T l-r
CITY OF NORTHAMPTON
�• +� MASSACHUSETTS
$ f OFFICE of -the INSPECTOR of BUILDINGS
�T Page Plot APPLICATION FOR
INSPECTOR ZONING PERMIT AND
BUILDING PERMIT
z
IMPORTANT — Applicant to complete all items in sections: 1, 11, 111, IV, and IX. O
�[( ZONING
I• AT (LOCATION) h U �JZ DISTRICT
LOCATION (RO•) // '' (5 TR EET)
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
1 XNew building Re ' ential Nonresidential
2 ❑
Addition residential, enter number 12 One family 18 ❑ Amusement, recreational
of new housing units added, if any, 13 wo or more family — Enter 19 ❑� Church, other religious
in Part D, 13) number of uni t s— — — — —>
3 ❑ Alteration (See 2 above) 20 ❑ Industrial
14 ❑ Transient hotel, motel, 21 Parking garage
4 ❑ Repair, replacement or dormitory — Fnter number
5 ❑ Wrecking (It multifamily residential, of units ——————— — -- 22 L 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)
7 ❑ Foundation only 17 L] Other — Specify � 25 ❑ Public utility
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
processing plant, machine shop, laundry building at hospital, elementary
10. Cost of improvement,,,,,,,,,,,,,,,, school, secondar y 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 $
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 40 Public or private company 48. Number of stories.............
31 ❑Wood frame osonry (wall bearing) 41 rivate (septic tank, etc.) 49• Total square feet of floor area t
all floors, based on exterior
32 ❑ Structural steel dimensions ....................
33 ❑ Reinforced concrete H. TYPE OF WATER SUPPLY
34 ❑ Other — Specify 42 ublic or private company 50. Total land area, sq. ft. ...........
43 t (well, cistern) K. NUMBER OF OFF-STREET
PARKING SPACES
F. PRINCIPAL TYPE OF HEATING FUEL 1. TYPE OF MECHANICAL 51. Enclosed .......................
35 ❑ GasWill there be central air 52. Outdoors........................
36 ❑ Oil conditioning? L. RESIDENTIAL BUILDINGS ONLY
37 j Electricity 44 Yes 45 4 j No
— . 53. Number of bedrooms..............
38 ❑ Coal
39 Other — Specify Will there be an elevators Full..........
54. Number of
46 �1 Yes 47 !o bathrooms portial.......
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