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NOTES and Data — (For department use)
�T
IV. IDENTIFICATION — To be completed by all applicants
Name Mailing address — Number, stmt, city, and State ZIP code Tel. No,
k7 �-�
Owner or
Lessee
+ Builder's
License No.
2.
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 date
00 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 Obttai ed Number By Permit or Approval Check 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
VII. VALIDATION
Building FOR DEPARTMENT USE ONLY
Permit number
Building. Use Group
Permit issued (�6F/�_ 7 19 _
Fire Grading
Building
Permit Fee $
Live Loading
Certificate of Occupancy $ Occupancy Load
Approved by:
Drain Tile $
Plan Review Fee $
TITL
J
�o o CITY OF NORTHAMPTON
MASSACHUSETTS
B �
{' OFFICE of the INSPECTOR of BUILDINGS
Page /
Plot ,1_ APPLICATION FOR
ZONING PERMIT AND
INSPECTOR BUILDING ' PERMIT
IMPORTANT — Applicant to complete all items in sections: 1, 11, 111, IV, and IX. O
ZONING
I• AT (LOCATION) 1� DISTRICT
LOCATION (N O•) EET)
OF BETWEEN AND
BUILDING (CROSS STREET) (CROSS STREET)
LOT
SUBDIVISION LOT BLOCK SIZE
H
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 � Addition(If residential, enter number 12 �I One family 18 Amusement, recreational
of new housing units added, if any,
added, any, `^^
in Part D, 13) 13 Two or more family — Enter 19 Church, other religious
number of units— — — — --� 20 F Industrial
3 Alteration (.Sec: 2 above) 14 � Transient hotel, motel,
21 Parking garage
4 �� Repair, replacement or dormitory — Enter number
5 �_ Wrecking (11 multifamily residential, of units ------- — -- 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)
17K Other — Specify 25 n Public utility
7 Foundation only J�� 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,,,,•,,,,,••,,,• 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 I$
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. TYEOF SEWAGE DISPOSAL J. DIMENSIONS
30 Masonry (wall bearing) 40 Public or private company 48. Number of stories.......
31 IJ� Wood frame 41 El Private (septic tank, etc.) 49• Total square feet of floor area,
//��� �� all floors, based on exterior
32 Structural steel dimensions .....................
33 Reinforced concrete H. TY E OF WATER SUPPLY
50. Total land area, sq. ft. ..........
34 �� Other — Specify 42 Public or private company
43 Private (well, cistern) K. NUMBER OF OFF-STREET
PARKING SPACES
�..
F. PRkN5IPAL 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 NLY
37 Electricity 44 Yes 45X, No 53. Number of bedroons-r- ......
38 Coal 111111
39 Other — Specify Will there be an elevators 54. Nu Full..........
46 _ Number of
) Yes 47X No bathrooms Partial........
l
Q
INSPECTION RECORD
DATE NOTE PROGRESS - CRITICISMS AND REMARKS INSPECTOR
FIELD COPY
4PARTMENT OF WILDING INSPECTIONS
112 MAIN STREET BUILDING
NORTH/4NnXIII, MA. 01464 PERMIT
17C - 126
*1 Cooper October 27, 19 PERMIT NO. 647
APPLICANT Ronald Cooper _ ADDRESS P.Q. Box. 1710 Florence
I (NO.) (STREET) (CONTR'S LICENSE)
�7.2� NUMBER OF
PERMIT TO Wi1fi3LieY & stove ( 2 ) STORY For wood-bnrnin �� DWELLING UNITS 1
(TYPE OF IMPROVEMENT) NO. (PROPOSED USE
t ZONING
AT (LOCATION) 67 No. file St. DISTRICT
(N0.) (STREET) $.
rn BETWEEN D
(CROSS STREET) c +i' (CROSS STREET)
LOT
IL SUBDIVISION � LOT BLOCK— SIZE
a
U
O BUILDING IS TO BE FT, WIDE BY j"If. LO BY —FT. IN HEIGHT AND SHALL CONFORM IN CONSTRUCTION
0
Z TO TYPE USE GROUP BASEMENT WALLS OR FOUNDATION
f (TYPE)
LL REMARKS: Construct exterf ar imaSAnary chiumev and install vood-burning stove
AREA OR
VOLUME ESTIMATED COST . . FERMIT
150000 s 10.00
(CUBIC/SQUARE FEET) ?
OWNER Ronald & Janet Cooper /
ADDRESS P.O. Box 171, Florence, Ma. 01060 BUI .P
BY
v
hereby certify that the proposed work is authorized by the owner df record
and I have been authorized by the owner to make this application as, his
authorized agent.
\
SIGNATURE OF AGENT
ADDRESS
(NUMBER) (STREET) (CITY)
APPROVED BY TITLE
DATE 19
DEPT. FILE COPY
DEPAR'1'MEN'1 OF BUILDING INSPECTIONS BUILDING LDI RIG �` � �►, oQ �a/a r%
212 MAIN STREET NOR`MAWTONO MA. 01060 PERMIT
- VALIDATION
17C « 126
DATE Ortobpr 27, 19_$Q�_ PERMIT NO. 647
APPLICANT Ronald roopar ADDRESS Florence
(N0, (STREE ) (CONTR'S LICENSE)OF
PERMIT TO (_�) STORY ' gg�DWEBLRNG UNITS
TYpE OF MPROVEMENT) N0. (PROPOSED US
ZONING
AT (LOCATION) 6�7 r M8 St-t-
DISTRICT
(S
(NO.) TREET) -
a BETWEEN AND.
'0 (CROSS STREET) (CROSS STREET)
01
LOT
a SUBDIVISION LOT BLOCK SIZE
m
U
O BUILDING IS TO BE FT. WIDE BY FT. LONG BY FT. IN HEIGHT AND SHALL CONFORM IN CONSTRUCTION
a
O
Z TO TYPE USE GROUP BASEMENT WALLS OR FOUNDATION
g (TYPE)
O
REMARKS:
AREA OR VOLUME ESTIMATED COST $_ 15CaNG FEEMIT 10.00
(CUBIC/SQUARE FEET)
OWNER Ronald & Janet Cooper
BUIL
ADDRESS p.O- Box 171TF1oreu�eTMA. 01060 BY
(Affidavit on reverse side of application to be completed by authorized agent of owner)