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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)