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REAR 1
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NOTES and Uwta — (For department use)
IV. IDENTIFICATION — To be completed by all applicants
Name Mailing address — Number, street, city, and State ZIP code Tel. No.
1. \4\ r G to(.0 04y-313
Owner or �+
Lessee
Builder's
2. C �� 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
. ��- l(:� \ IV- - Clof� )
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 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
II. VALIDATION
Building FOR DEPARTMENT USE ONLY
Permit number
Bui Iding. f j Use Group
Permit issued �[J-�'� I9q
Building Fire Grading
Permit Fee $ f t? �;�!
Live Loading
Certificate of Occupancy $ Occupancy Load
Ap d by:
Drain Tile $
Plan Review Fee $
TITLE
CITY *F Ar RTHAMPTON
MASSACHUSETTS
6
OFFICE of the INSPECTOR of BUILDINGS
ti � -7
T Page Plot_ 7 7 APPLICATION FOR
INSPECTOR ZONING PERMIT AND
BUILDING PERMIT
IMPORTANT — Applicant to complete all items in sections: 1, 11,`111, IV, and IX. O
I. AT (LOCATION) I.�� I \_){ �)tj `•l��� \ .��, \— `�� t ZONING U/V
LOCATION (NO.) (STREET)
OF BETWEEN AND
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
2 Addition(if residential, enter number 12 One family 18 ❑ Amusement, recreational
of neru housing units added, if any,
13 Two or more family — Enter 19 Church, other religious
n Part D, 13) Y ❑ 9�
number of units— — — — � 20 �� Industrial
3 dAlteration (See 2 above) 14 ❑ Transient hotel, motel,
21 ❑ Parking garage
4 ❑ Repair, replacement or dormitory — Enter number
5 ❑ Wrecking (if multifamily residential, of units ——————— — --30- 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 IMrkeq 0�— 27 ❑ Stores, mercantile
8 Private (individual, corporation, \ l 28 ❑ Tanks, towers
nonprofit institution, etc.) fx?t- �}�Q;CC9v e _ 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 $
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 ❑ 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
51. Enclosed .......................
F. PRINCIPAL TYPE OF HEATING FUEL I.TYPE OF MECHANICAL
35 �� Gas There be central air , 52. Outdoors.......................
36 ` Oil conditi ing"
L. RESIDENTIAL BUILDINGS ONLY
37 E� Electricity 44 Yes 45 —I No 53. Number of bedrooms..............
38 ❑ Coal
39 Cj Other — Specify Will ther�lbe an elevator? Full....�....
54. Number of
)4 Yes 47 i,❑ No bathrooms
Partial.......
INSPECTION RECORD :
DATE NOTE PROGRESS - CRITICISMS AND REMARKS INSPECTOR
+► FIELD COPY
�.
BUILDING
�- , PERMIT
177
DATE ...t'�'V t 9%���R-E I T
APPLICANT AdORESS
(N0.) (STREET) (CONTR'S LICENSE) JJJ�
�9 NUMBER OF '
PERMIT TO) (^) STORY DWELLING UNITS
(TYPE OF IMP OVEMENT) NO. ( OPOSEO USE)
ZONING
AT (LOCATION) DISTRICT
(N0.) (S EE
J� 1
rn BETWEEN AND j
(CROSS STREET) '; (CROSS STREET)
LOT
SUBDIVISION m SUBDIVISION _L L CK SIZE
a
p BUILDING IS TO BE FT. WIDE BY FT.\,ONG BY FT. IN HEIGHT AND SHALL CONFORM IN CONSTRUCTION
m
i
Z TO TYPE USE GROUP BASEMENT WALLS OR FOUNDATION
f (TYPE)
LL REMARKS:
j
a
� AREA OR fVV � PERMIT � •~
VOLUME -ESTIMATED COST $ FEE
(CUSI /SQUARE FEET)
OWNER
BU( I Tjj
ADDRESS BY �`