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NOTES and Data — (For department use)
IV. IDENTIFICATION To be completed by all applicants
Name Mailing address Number, cif%, (ind �tatc ZIP code T,1. NO.
Owner or
Lessee
Contractor
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 Addr ss Applica,tion date
00 N 0 T WR | TE BELOW TH | 3 LINE
V. PLAN REVIEW RECORD For office use
Plan Review Do te Plans Date Plans
Sta TO
Plans Review Required Check By By Notes
Fee Started A oved
BUILDING $ pp,
PLUMBING
MECHANICAL
ELECTRICAL
OTHER
VI. ADDITIONAL PERMITS REQUIRED OR OTHER JURISDICTION APPROVALS
Do te Date
Permit or Approva I 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
Permit number
Building
Permit issued 19,,2r
Building
Permit Fee $
Certificate of Occupancy
Approved by:
Drain Tile
Plan Review Fee
LE
. ^
� � �IassMClptsetfs
T Offire of the 31napertor of�uilbittgs
4- APPLICATION FOR
Pager Plot ^ ZONING PERMIT AND
BUILDING PERMIT
IMPORTANT — Applicant to complete all items in sections: 1, 11, 111, IV, and IX.
O
AT (LOCATION) L-�..4.1.,:'rk". �J r ,.( DISTRICT
.
)CATION (N0.) (STREET)
BETWEEN �y; � c..� .,, r t._. .,.. AND
JILDING (CROSS STREET) ��,��, l^ (CROSS STREET)
LOT
yyyyyy���
SUBDIVISION LOT BLOCK SIZE
f/f
TYPE AND COST OF BUILDING — All applicants complete Parts A — D
TYPE OF IMPROVEMENT D. PROPOSED USE — For"Wrecking" most recent use m
m
1 [New building Resident' I Nonresidential
20 Addition(If residential, enter number 12 One family 18 0 Amusement, recreational
of new housing units added, if any,
in Part D, 13) 13 Two or more family — Enter 19 0 Church, other religious
number of units— — — — —> 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 —_--_-- — -� Service station, repair garage
enter number of units in building in 15 Garage 23 Hospital, institutional
Part D, 13)
16 Carport 24 E] Office, bank, professional
6 Moving (relocation)
17 Other — SpeciJy. 25 � Public utility
7 Foundation only 26 School, library, other educational
3. OWNERSHIP 27 F-1 Stores, mercantile
8 U�rivate (individual, corporation,
28 Tanks, towers
nonprofit institution, etc.) 29 Other — Specify
9 E] 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,,,,,,,,,,,,,,,, ;"=l r" school, secondary school, college, parochial school, parking garage for,
department store, rental office building, office building at industrial plant.
To be insealled 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 $ ��1,C i�
il. SELECTED CHARACTERISTICS OF BUILDING — For new buildings and additions, complete Ports E — L,
for wrecking, complete only Part J, for all others skip to IV. D
E. PRINCIPAL TYPE OF FRAME G. TYPE OF SEWAGE DISPOSAL J. DIMENSIONS 0
.. m
30 n Masonry (wall bearing) 40 r-1 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 �i ublic or private company 50. Total land area, sq. ft. ...........
43 ❑ Private (well, cistern) K. NUMBER OF OFF-STREET
PARKING SPACES
.Q
F. PRINCIPAL TYPE OF HEATING FUEL 1. TYPE OF MECHANICAL 51. Enclosed """""""""""' r
O
35 0 Gas Will there be central air 52. Outdoors........................
36 000 conditioning?
L. RESIDENTIAL BUILDINGS ONLY
37 D Electricity 44 0 Yes 45 ON 53. Number of bedrooms..............
38E] Coal
39 E Other — Specify Will there be an elevator? Full,,,,,,,,,,
�-�, 54. Number of
46 F es Yes 47 1 ' I No bathrooms i`
Partial....... i
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I hereby certify that the proposed work is authorized by the owner of record
and I have been authorized by the owner to make this application us h+s
authorized agent.
SIGNAT6RE OF` AGENT
ADDRESS
(NUMBER) (STREET) (CITY)
APPROVED BY TITLE
DATE 19
BUILDING ZD
DEPT. PILE COPY
CITY OF NORTHAMPTON 2 IL
NORTHAMPTON, MA. 36.69 PERMIT VALIDATION
DATE June 27, 19 7,9 _ PERMIT NO. 294
APPLICANT Theodore Towne ADDRESS PNO Park 1' IR
�NO.) (STREET)V_ N'tnn� (CONY R'S LICENSE{
OF
PERMIT TO New residence (_�) STORY RP41 C3pnoe DWELLLRING UNITS 1
(TYPE OF IMPROVEMENT) NO. (PROPOSED USE)
AT (LOCATION) Burts Pit Road ZONING SE
DISTRICT
(NO.) - (STREET)
rn BETWEEN Florence AND Ryan.
(CROSS STREET) (CROSS STREET)
w_ it it
Aw
LOT
SUBDIVISION m SUBDIVISION LOT BLOCK SIZE
a
U BUILDING IS TO BE 26 FT. WIDE BY 90 FT. LONG BY FT. IN HEIGHT AND SHALL CONFORM IN CONSTRUCTION
M
O
Z TO TYPE USE GROUP BASEMENT WALLS OR FOUNDATION
� (TYPE)
° REMARKS: ____Construct one-family residence
AREA OR VOLUME _ 19nn ESTIMATED COST $ 24,000 FFEEMIT $ 72,00
(CUBIC/SQUARE FEET)
OWNER Theodore Towne
BUI4NGD T.
ADDRESS 53 Park H-i 1] Rd_ r N I tnn_ BY
(Affidavit on reverse side of application to be completed by authorized agent of owner)