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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, and State ZIP code Tel. No.
1
Owner or. l'C
Lessee -� - C f f J t
Builder's
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 pplicant Address �G / Application date
G/
171/v A
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 ObDtaained Number By Permit or Approval Check Obtta t ed Number By
BOILER PLUMBING
CURB OR SIDEWALK CUT ROOFING
ELEVATOR SEWER
ELECTRICAL I SIGN OR BILLBOARD
FURNACE STREET GRADES
GRADING USE OF PUBLIC AREAS
OIL BURNER WRECKING
OTHER OTHER
VII. VALIDATION
Building J / FOR DEPARTMENT USE ONLY
Permit number `Y
Building Use Group
Permit issued 19 f
Building , f Fire Grading
Permit Fee $ d "' Live Loading
Certificate of Occupancy $ Occupancy Load
Approved by:�
Drain Tile $ ���'�'/e""�`"S � � •
Plan Review Fee $
TITLE
CITY OF NORTHAMPTON
�+ MASSACHUSETTS
r
$ 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
•.. '^f,�� „. ,[y ZONING
I•
AT (LOCATION) �"�... k=,� DISTRICTS`
LOCATION (NO.) (5TREET)
O FC f `r AND J 1 1. L._. r --�
BETWEEN {-- ----
BUILDING (CROSS STREET) (CROSS STREET)
LOT
SUBDIVISION LOT BLOCK SIZE
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 ❑ New building Residential Nonresidential
20 Addition(/ residential, enter number
/ 12 F-1 One family 18 Amusement, recreational
of new housing units added, if any,
in Part D, 13) 13 Two or more family - Enter 19 n Church, other religious
number of units- - - - --jo. 20 Industrial
3 D Alteration (See 2 above)
14 Transient hotel, motel,
4 El Re air, re lacement -- 21 Parking garage
P P or dormitory - En[er number
5 El Wrecking (1l multifamily residential, of amts -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)
7 � Foundation only 17 �_� Other - Spec'/y 25� � Public utility
26 F] School, library, other educational
B. OWNERSHIP 27 LJ Stores, mercantile
8 CJ 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,,,,,,,,,,,,,,,, J�`�'° 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 $
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❑ Masonry (wall bearing) 40 Public or private company 48. Number of stories................
31 [--] Wood frame 41 n 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
Public or private company 50. Total land area, sq. ft. ..........
34 Other - Specify 42
43 ❑ Private (well, cistern) K. NUMBER OF OFF-STREET
PARKING SPACES
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 j Electricity 44 Yes 457', No
--. 53. Number of bedrooms..............
38 Coal
39 Other - Specify Will there be an elevators Full..........
_ 54. Number of
46 [_, Yes 47 '_j No bathrooms
Partial.......
DEPT. Of BUIWING INSPECTIONS BUILDING z° �0/ x) , �)C)
! 212 Main Street 04
Northampton, MA 01060 PERMIT
17A - 127 VALIDATION
DATE 1 )1 V 10 ER
APPLICANT IT NO. 4;0
Richard Wanczyk a ADDRESS rl ge �toa� Owner
(NO.) (STREET) (CONTR'S LICENSE)
New Chimney One Family NUMBERNG OF
UNITS
PERMIT TO (_) STORY
NO. (PROPOSED USE)
Bridge Roa ZONING URA
AT (LOCATION) DISTRICT
(NO.) (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:
AREA OR 300.00 FEEMIT $ 10.00
VOLUME ESTIMATED COST ,
(CUBIC/SQUARE FEET)
OWNER Same as Applicant
ADDRESS Same as Applicant's BYI
WHITE - FILE COPY P GREEN - FIELD COPY • CANARY ^ APPLICANT COPY • PINK ASSESSORS COPY PAINT P
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