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29-426 (3) VIII. ZONING PLAN EXAMINERS NOTES DISTRICT USE Ai s FRONT YARD SIDE YARD SIDE YARD REAR YARD NOTES IX. 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IV. IDENTIFICATION — To be completed by all applicants Name Mailing address — Number, street, city, and State ZIP code Tel. No. Owner or 0 6, Owner - �� ��. llole j 171 a&C) C.��Y� 2 Lossee Builder's 2. License No. Contractor C 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 p� Address Application date 00 NOT WRITE BELOW THIS LINE V. PLAN REVIEW RECORD — For office use Plan Review Date Plans Date Plans Plans Review Required Check Fee Started BY Approved BY Notes BUILDING PLUMBING MECHANICAL ELECTRICAL OTHER VI. ADDITIONAL PERMITS REQUIRED OR OTHER JURISDICTION APPROVALS Date Date Permit or Approval Check Obtai ed 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 -j FOR DEPARTMENT USE ONLY Permit numberJ� Building Use Group Permit issued tb {z7 ° 19 f Fire Grading Building Permit Feel Live Loading Certificate of Occupancy $ Occupancy Load Approved by: Drain Tile Plan Review Fee e NOTES and Data — (For department use) "Oqo �A CITY OF NORTHAMPTON OFFICE OF THE INSPECTOR OF BUILDINGS 212 MAIN STREET APPLICATION FOR NORTHAMPTON, MA. 01060 PLAN EXAMINATION AND BUILDING PERMIT z IMPORTANT — Applicant to complete all items in sections: 1, 11, 111, IV, and IX. O l/ ll!©� �� /—t t!i���✓1C� �. �l(d ZONING / I• AT (LOCATION) DISTRICT LOCATION (NO.) (STREET) 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 A. TYPE OF IMPROVEMENT D. PROPOSED USE — For"Wrecking" most recent use m m 1 [j��ew building Residential Nonresidential 2 Addition(If residential, enter number 12 One family 18 ❑ Amusement, recreational of new housing units added, if any, in Part D, 13) 13 ❑ Two or more family — Enter 19 ❑ Church, other religious 3 ❑ Alteration (See 2 above) number of units— — — — --> 20❑ Industrial 14 ❑ Transient hotel, motel, 21 ❑ Parking garage 4 ❑ Repair, replacement or dormitory — Enter number 5 ❑ Wrecking (If 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) 17 Other — Specify 25 ❑ Public utility 7 ❑ Foundation only 26 ❑ School, library, other educational B. OWNERSHIP ����<'��eC� 14V2�� 111-6127 ❑ 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................ 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 1$ 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 J 30 RMasonry(wall bearing) 40 Public or private company 48• Number of stories..............31 Wood frame 41 ❑ 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 34❑ Other — Specify 42 ❑Public or private company 50. Total land area, sq. ft. ........... 43 ❑ Private(well, cistern) K. NUMBER OF OFF-STREET PARKING SPACES F. PRINCIPAL TYPE OF HEATING FUEL I. TYPE OF MECHANICAL 51. Enclosed ....................... 35❑ Gas Will there be central air 52. Outdoors........................ conditioning? 36 ❑ Oil L. RESIDENTIAL BUILDINGS ONLY 37 Electricity 44❑ Yes 45 D No 53. Number of bedrooms.............. 38 ❑ Coal / 39❑ Other— Specify Will there❑ be an elevator? Full....../... / / 54. Number of 46 Yes 47 No bathrooms Partial....... �/ ?y, b # ��4 � '?`& vr- � � �ms's'. k s �„'- �` �- sir ,,,,�. �,� .' .R it ��.. � � � n �: i � S4 "'�" t � �,�y�" � '4s � � _ �`'� .5K � #a"4 ,ic,a `* .:�+. s a« ��,. .; �. �� F� � �� z�z f..'� x3,�. :� ,,,,,. � ' ���� '�� "'�.*,� .� � s'� . ,�� ��, �f ;_� � � � ��r�M �� y A 1% ^d �ti6 r: f ��'�,;+' sue' �-+'� �, � �' �, ,` � � �� � � "��, P. t � t,� .� � `` �', s.' arm�°�- .. t4 at'�° t � �``' '. �'�`�? f _ c+� s �... M.:+ �;�r „� � ix ,�' � :�' � b� n r� ,.�4 �.:, � ^�xw -a,. r At 's � E: 4. r a ,q }x s Fs y, #v F x r Yom. » �s M 3� �F us a.�i—M.._!w�'.:.�` I hereby certify that the proposed work is authorized by the owner' of record and 1 have been authorized by the owner to Make-lthis' dpplication cg's H-I!& authorized agent. SIGNATURE 0r AGtNT ADDRESS (NUMBER) (STREET) (CITY) APPROVED BY TITLE DATE 19 i DEPT. FILE COPY ZO DEPT. OF BUILD%IG.JNSPECnONS 0 a 212 Marl Sf @@t BUILDING as Nornhampwn, Mass.01M 29-426 PERMIT VALIDATION DATE Sntember 15, 19 8 — PERMIT NO. APPLICANT Dj ane Rrajfo-rd ADDRESS (;n� Dr. M n (N0.) (STREET). (CONTR'S LICENSE) NUMBER OF PERMIT TO Chimney ( j STORY Masonary Chimney DWELLING UNITS (TYPE OF IMPROVEMENT) NO. (PROPOSED USE) ZONING AT (LOCATION) 71 Golden Drive, DISTRICT HEAL (NO.) (STREET) - a BETWEEN AND 'o (CROSS STREET) (CROSS STREET) a 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 O O Z TO TYPE USE GROUP BASEMENT WALLS OR FOUNDATION I (TYPE) IL REMARKS: Add Maanna= nhirrrnatr -fnr Wrnnd hiirni ng 4i'ntra AREA OR $ VOLUME ESTIMATED COST $ 200.00 FEEMIT X0.00 (CUBIC/SQUARE FEET) OWNER Richard 0 Diane _ Rr c�ford BUILDI G P . ADDRESS 71 Golden nri ye, Fl nreno,-, Me- BY (Affidavit on reverse side of application to be completed by authorize agent of owner)