11A-071 (2) FORM NO. BOCA-BP 1969
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IV. IDENTIFICATION — To be completed by all applicants
Name Mailing address — Number, street, city, and State ZIP code Tel. No.
O wner or {IRK S /Al[MAA/A E L =Nl i Cl �� !
Lessee
Al0 ro AA 7-0/v
Builder's
2. ('/it < S V tk)S i+ fIli
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
e..%5 l x ,✓a�, /f r T,_-- i
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
9 Fee Started y Approved y
BUILDING
PLUMBING
MECHANICAL
ELECTRICAL
OTHER
VI. ADDITIONAL PERMITS REQUIRED OR OTHER JURISDICTION APPROVALS
Date Permit or Approval 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 FOR DEPARTMENT USE ONLY
Permit number 3f%2_ j
Building Use Group
Permit issued /3 1972_
Building Fire Grading
Permit Fee $ (0003 Live Loading
Occupancy Load
Certificate of Occupancy
Appr• ed by:
Drain Tile (4.\
. w
Plan Review Fee
TITLE
f
NOTES and Data — (For department use)
#111—!41/ 4 _J/t.
j `j,
CITY OF NORTHAMPTON
OFFICE OF THE INSPECTOR OF BUILDINGS
212 MAIN STREET APPLICATION FOR
NORTHAMPTON, MA. 01060 / PLAN EXAMINATION AND
f f 7/ BUILDING PERMIT
IMPORTANT — Applicant to complete all items in sections: I, II, Ill, IV, and IX. 0
_ A, ONING { /�
I. AT (LOCATION) F+- �.Llv 77-=_W Si .�• DISTRICT R_�f�•"j'
LOCATION (NO.) (STREET)
OF BETWEEN AND
BUILDING (CROSS STREET) (CROSS STREET)
LOT SUBDIVISION LOT BLOCK SIZE -,e", Pit'( y.. P 2.
N
II. TYPE AND COST OF BUILDING — All applicants complete Parts A — D —1
73
A. TYPE OF IMPROVEMENT D. PROPOSED USE — For"Wrecking" most recent use m
m
1 New building Residential Nonresidential
2 [ I Addition(If residential, enter number 12 1;4 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
in
number of units— — — — --> 20 I Industrial
3 I I Alteration (See 2 above)
14 I I Transient hotel, motel, 21 I Parking garage
4 I I Repair, replacement or dormitory — Enter number
5 I Wrecking (If multifamily residential, of units — —0- 22 I Service station, repair garage
enter number of units in building in 15 XLGarage 23 Hospital, institutional
Part D, 13)
16 I I Carport 24 I Office, bank, professional
6 I I Moving (relocation)
17I I Other — Specify 25 Public utility
7 I Foundation only
26 I School, library, other educational
B. OWNERSHIP 27 j Stores, mercantile
8 *fl.. Private (individual, corporation, 28 Tanks, towers
nonprofit institution, etc.) 29 Other — Specify
9 I I 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 )
11. TOTAL COST OF IMPROVEMENT _$ Z ' ()Cr
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 L J Masonry (wall bearing) 40 Public or private company Number of stories
31 Wood frame 41 I I Private (septic tank, etc.) 49. Total square feet of floor area, tit; 2.`-
all floors, based on exterior
32 Structural steel dimensions j5
33 Reinforced concrete H. TYPE OF WATER SUPPLY
34 I I Other — Specify 42 K Public or private company 50. Total land area, sq. ft. /I c r
43 I I Private (well, cistern) K. NUMBER OF OFF-STREET
PARKING SPACES
51. Enclosed i
F. PRINCIPAL TYPE OF HEATING FUEL I. TYPE OF MECHANICAL
35 I I Gas Will there be central air 52. Outdoors
361 I Oil conditioning? L. RESIDENTIAL BUILDINGS ONLY
37 I I Electricity 44 I I Yes 45.N No 53. Number of bedrooms -
38I Coal
39I Other — Specify j",--L,91 NA..1) Will there be an elevator? Full E
54. Number of
46 I I Yes 47.RI No bathrooms
Partial L. '