37-014 (2) IV. IDENTIFICATION — To be completed by all applicants
Dame Mailing address — Number, street, city, and State ZIP code Tel. No.
1. �p
Owner or 3� ��f +' = �trti��
Lessee tG'
/ / 3
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 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
2
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
q Fee Started y Approved y
BUILDING
PLUMBING
MECHANICAL
ELECTRICAL
OTHER
VI. ADDITIONAL PERMITS REQUIRED OR OTHER JURISDICTION APPROVALS
Permit or A rova I Check Date Number By Permit or Approval I Check Date Number By
Obtained y pp Obtained y
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 r Use Group
Permit issuedP. , S 19 /
Fire Grading
Building
/' Permit Fee � G Live Loading
Occupancy Load
Certificate of Occupancy $
Approved by:
Drain Tile
Plan Review Fee $ / v AfirffA5
�`� TIT LE,
N
dt
NOTES and Data — (For deportment use)
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CITY OF NORTHAMPTON
OFFICE OF THE INSPECTOR OF BUILDINGS
212 MAIN STREET APPLICATION FOR
NORTHAMPTON, MA. 01060 PLAN EXAMINATION AND
BUILDING PERMIT
IMPORTANT — Applicant to complete all items in sections: I, II, III, IV, and IX. 0
I. AT (LOCATION) K/�a / ,_° ZONING
[ S ! t� {�. (1- t9,.,.�,G - y /?, DISTRICT s,
LOCATION (NO.) (ST 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 -4
23
A. TYPE OF IMPROVEMENT D. PROPOSED USE - For "Wrecking" most recent use m
M
1 I I New building Residential Nonresidential
2Addition residential, enter number 12(One family 18 I Amusement, recreational
of new housing units added, if any,
in Part D, 13) 13 I I Two or more family - Enter 19 Church, other religious
number of units- - - - --0. 20 I Industrial
3 I I Alteration (See 2 above)
14 I I Transient hotel, motel, 21 Parking garage
4 I I Repair, replacement or dormitory - Enter number
5 1 I Wrecking (If multifamily residential, of units - -* 22 I Service station, repair garage
enter number of units in building in 15 I I Garage 23 I Hospital, institutional
Part D, 13)
16 I 1
Carport 24 I Office, bank, professional
61 I Moving (relocation)
I 17 Other - Specify 25 Public utility
7 I Foundation only
26 School, library, other educational
B. OWNERSHIP U ''" - 27 j Stores, mercantile
28 Tanks, towers
8 ;Y1,.. Private (individual, corporation, 29 nonprofit institution, etc.) I Other - Specify
9 1 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, 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 )
1 1 . TOTAL COST OF IMPROVEMENT $� C - 1767
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 q
48. 30 n Masonry (wall bearing) 40 1 1 Public or private company Number of stories cg,
31 Wood frame 41 fA Private (septic tank, etc.) 49. Total square feet of floor area,
all floors, based on exterior
32 I Structural steel — dimensions
331 Reinforced concrete H. TYPE OF WATER SUPPLY
34 1 I Other - Specify 42 Public or private company 50. Total land area, sq. ft.
43 I I Private (well, cistern) K. NUMBER OF OFF STREET
PARKING SPACES
51. Enclosed
F. PRINCIPAL TYPE OF HEATING FUEL I. TYPE tF MECHANIC' L
351 I Gas Will there •e centra •ir 52. Outdoors
361 I Oil conditionin• L. RESIDENTIAL BUILDINGS ONLY
37'2 Electricity 44 I I Yes 45 L I No 53. Number of bedrooms �>
38 1 I Coal
39 I 1 Other - Specify Will th- e be an elevator? 1 Full '"2""
54. Number of
461 I Yes 47 I No bathrooms
Partial
".
I hereby certify that the proposed work is authorized by the owner of re4rd
and I have been authorized by the owner to make this application 4 as his
authorized agent.
SIGNATURE' OF AGENT
ADDRESS
(NUMBER) (STREET) (CITY)
APPROVED BY TITLE
DATE 19 .
D PT. FILE COPY
DEPARTMENT OF BUILDING INSPECTIONS BUILDING f -c-' �.
212 MIK STREET a ` L-
NORTHAMPTON, MA. 01060 PERMIT VALIDATION
37 -- 14 Code #79
DATE October 15, 19 79 PERMIT NO. 597
APPLICANT r urge 'Haller ADDRESS 651 Flni'Pnna Rd.
(NO.) (STREET) (CONTR'S LICENSE)
NUMBER OF
PERMIT TO Install wood stove ( 2) STORY Wood burning stove DWELLING UNITS 1
(TYPE OF IMPROVEMENT) NO. (PROPOSED USE)
ZONING
AT (LOCATION) 651 Florence Road DISTRICT SR
(NO.) (STREET)
at BETWEEN AND
m (CROSS STREET) (CROSS STREET)
at
LOT
a
m SUBDIVISION LOT BLOCK SIZE
U
O BUILDING IS TO BE FT. WIDE BY FT. LONG BY FT. IN HEIGHT AND SHALL CONFORM IN CONSTRUCTION
m
O
Z TO TYPE USE GROUP BASEMENT WALLS OR FOUNDATION
f (TYPE)
re
U. REMARKS: , T )stall wonI.- hurn stove in existing fireplace (lined chimney)
AREA OLUME ESTIMATED COST $ 330.00 FEEMIT $ 10.00
(CUBIC /SQUARE FEET)
OWNER aenrgp Hal l Pr ' / f l /
BUILD G I P ,
ADDRESS 651 orence Rd. , N'ton. BY - ., ∎ `�..�
(Affidavit on reverse side of application to be completed by authorized agent of owner)