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IDENTIFICATION — To be completed by all applicants Name Mailing address — Number, street, cirv, and State ZIP code Tel. No. 1. / 3S� Owner or Lessee D/Or'o U 2. / 6�`JG f'�. ? Q/ Gov LBcenserNo. Contractor 4^ ,/ y ©t�p 7 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_A applicant Address Application date 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 f FOR DEPARTMENT USE ONLY Permit number �o( ' Building. ,9� "�, Use Group Permit issued —24' Z,-Y6, 4- fT_ 19_� Building �+ Fire Grading Permit Fee $ °7 Live Loading Certificate of Occupancy $ Occupancy Load Approved by: Drain Tile $ e.^1 Plan Review Fee $ TITLE CITY OF NORTHAMPTON �• MASSACHUSETTS e $ e OFFICE of the INSPECTOR of BUILDINGS wt Page Y Plot APPLICATION FOR INSPECTOR ZONING PERMIT AND BUILDING PERMIT z IMPORTANT — Applicant to complete all items in sections: 1, 11, Ill, IV, and IX. O ZONING -' AT (LOCATION) 173 West Fsa,rm& Rd . DISTRICT .... LOCATION (NO.) (STREET) L OF BETWEEN Ryan Rd. AND Rt b A fi BUILDING (CROSS STREET) (CROSS STREET) LOT SUBDIVISION LOT BLOCK SIZE N II. TYPE AND COST OF BUILDING — A11 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([ residential, enter number / 12 PC] 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 number of units- - - - -o- 20 ❑ Industrial 37 Alteration (See 2 above) 14 Transient hotel, motel, 21 ❑ Parking garage 4❑ Repair, replacement or dormitory - Enter number 5 ❑ Wrecking (If multifamily residential, of units ------- - --0- 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) 25 Public utility 17[::] Other - Speci/y ❑ Y 7 D Foundation only 26 School, library, other educational B. OWNERSHIP 27 ❑ 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 $ O �� 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 � Q 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 F_� Gas Will there be central air 52. Outdoors........................ 36 Oil conditioning? L. RESIDENTIAL BUILDINGS ONLY 37 Electricity 44 ❑ Yes 45 I� No 53. Number of bedrooms.............. 3B ❑ Coal 39 ❑ Other - Specify Will there be an elevator? Full.......... -� 54. Number of ID 46 [_-] �yJ Yes 47 L". No bathrooms Partial....... i DEPT: OF BUILDING INSPECTIONS BUILDING z°- �� cx 212 Main Street O< Northampton, MA 01060 PERMIT <a 35 - 13 VALIDATION DATE November 19, )g 85 PERMIT NO. 664 APPLICANT Walter Dziubek & Son ADDRESS P.O. BOX 38, Florence 008764 (NO.) (STREET) (CONTR'S LICENSE) Addition Famil y g(vin Room NUMBER OF PERMIT TO I_) STORY DWELLING UNITS (TYPE OF IMPROVEMENT) NO. (PROPOSED USE) 173 West Farms Road ZONING SR AT (LOCATION) DISTRICT (NO.) (STREET) BETWEEN AND (CROSS STREET) (CROSS STREET) LOT SUBDIVISION LOT BLOCK SIZE Addition XxgF IS TO BE 12 FT. WIDE BY 20 FT. LONG BY FT. IN HEIGHT AND SHALL CONFORM IN CONSTRUCTION TO TYPE USE GROUP BASEMENT WALLS OR FOUNDATION (TYPE) REMARKS: permit NKMM for the construction of a family/living room addition AREA OR 10.840.00 FEE MIT 40.00 VOLUME 24O SCi. ft. ESTIMATED COST (CUBIC/SQUARE FEET) OWNER Z igmund Korvek BUILDpyyLLa J ADDRESS 173 West Farms Road BY WHITE - FILE COPY . GREEN - FIELD COPY • CANARY - APPLICANT COPY ■ PINK - ASSESSORS COPY p}NT p