43-074 (3) -- . DEPT. FRE COPY
BUILDING i�O/ffi'
/�hLG4a,., PERMIT ��( ,/ca, ax �C
iii �] IDATION��
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.. 19 -E-MIT
APPLICAN 1—_ -00XE55 /YXr " G
I ja p +' (No.) MIRE ICOHTR•8 JCEXEEi
PERMIT TO 1" ...Mega-6
NUMBER OF
I TYPE OF IMPROVE*ERY) 1 X6. )41127 ,/STaiY SPROPflED VSE3 DWELLING UNITS
AT (LOCATION) RAF '2. DISTRICT—
(NO.) (STREET)
ch BETWEEN— AND
o o
(CROSS STREET) (CROSS STREET)
LOT
IL SUODIVISION LOT BLOCK 512E
p BUILDING IS TO SE £T. WIDE BY FT. LONG BY FT. IN HEIGHT AND SWILL CONFORM IN CONSTRUCTION
toO
z TO TYPE USE GROUP EASEMENT WALLS OR FOUNDATION
M (TYPE)
re0
K REMARKS:
AREA OR $ 2[�5�. .��� PERMIT //l/T /Ii
VOLUME ESTIMATED COST C=JU /f/J/(PRITTT FEE $� `Vy/f////C/ +1
OWNEN / / f FE BY7 BU lrlaiu�//i � <.+L.M1Y�—�"V
ADDRESS M �ST/ICIJ�"A
(Affidavit on reverse side of application to be completed by authorized agent of owner)
->I•hereby certify\that the proposed work is authorized by the owner'ofrecord '—
and
and I have been authorized by the owner to nioke‘this application.as-his -. ` -
authorized agent
SIGNATURE OF. AGENT
ADDRESS
(NUMBER) (STREET) (CITY)
APPROVED BY TITLE
DATE 19__.
• , 'eil , Citify of Xorthampton
�'I as5ar Items
ec`VIJY�Aeq:
te$F r�rw
m_ �>
Office of the 3Inspertax ofuilDings
r� APPLICATION FOR
Page r` Plot'7 ( ZONING PERMIT AND
BUILDING PERMIT
IMPORTANT — Applicant to complete all items in sections: I, II, III, IV, and IX. p
i
AT (LOCATION) I'� 1/ L' �') ihW Il�• ZONING
DISTNICS t...-„,.%IRO./
LOCATION t EST)
OF BETWEEN AND
BUILDING (CROSS STREET] (CROSS STREET/
LOT
SUBDIVISION LOT BLOCK SIZE
Cn
II. TYPE AND COST OF BUILDING — All applicants complete Pans A — D y
A. TYPE OF IMPROVEMENT D. PROPOSED USE - For"Wrecking" most recent use m
m
H
I El New building Residential Nonresidentialr
2I I Addition(If residential, enter number 12 VI One family IB Ll Amusement, recreational
o/'neu, housing units added, if any, 13 Two or more family - Enter 19 Church, other religious
Part D, 13)
number of units- - - - -1 201 I Industrial
3 I Alteration (See 2 above) 14 I Transient hotel, motel, - 21 1 1 Parkin
4 El Repair, replacement or dormitory - Enter number 9 garage
5 I I Wrecking (I/multifamilynits residential,in
of units y 22 I Service station, repair garage
enter D, 13) of units in building in 15 Garage 23 f Hospital, institutional
Part ]31 16 I Carport24 fl Office, bank, professional
6I I Moving (relocation)
T L Foundation only 171 I Other - Specify 25 l [ Public utility
(( 261 J School, library, other educational
B. OWNERSHIP L a? CJ'i.c-,vVsc i et 271 I Stores, mercantile
pp //--
28 L I Tanks, towers
8 I Private (individual, corporation, ri LYUn2,S /Jt6r"E_ 29Specify
nonprofit institution, etc.) (1'c0 Other - S
9 LJ Public (Federal, State, orOr
local government)
C. COST (Omit cents) Nonresidential - Describe in detail proposed use of buildings,e.g., food
V- processing plant, machine shop, laundry building at hospital,elementary
10. Cost of improvement $ .'f ')1 ), school, secondary school, college, parochial school, parking garage for
department store, rental office building, office building at industrial plant.
To be in railed but not included If use of existing building Is being changed, enter proposed use.
in She above cost
a. Electrical
b. Plumb' g
c. Heating, air conditioning
d. Other(elevator,etc )
II, TOTAL COST OF IMPROVEMENT $ , `r(r —
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. y
E. PRINCIPAL TYPE OF FRAME G. TYPE OF SEWAGE DISPOSAL J. DIMENSIONS
T
48. Number of stories
30 r] Maso (well bearing) 40 FTPublicor private company 49. Total feet of floor area,
Woodframe
31 X,Wood frame 41 W Pr/vete (septic tank, etc.) sgsare
all floors, based on exterior
32 1 Structural steel dimensions
33E• Reinforced concrete H. TYPE OF WATER SUPPLY
34 1 I Other - Specify 42 M_Public or private company 50. Total land area, sq. ft
431 I Private(well, cistern) K. NUMBER OF OFF-STREET
PARKING SPACES
r
F. PRINCIPAL TYPE OF HEATING FUEL I. TYPE OF MECHANICAL SL Enclosed
0
35I I Gas Will there be central air 52. Outdoors -H
361 1 Oil conditioning? L. RESIDENTIAL BUILDINGS ONLY
3V [S4 Electricity 44 J[ Yes 45 [[ No 53. Number of bedrooms
361 1 Coal
39 1 I Other - Specsfy Will there be an elevators { Full
54. Number of
461 I Yes 471 I No bathrooms
Partial
IV, IDENTIFICATION — To be co pteted by all applicants
Nome ZIP code T.51. Na'
.0.ry nora, ifll�l�LQ tit F3TKICf ls{��t -- +^- �qht jfl t4r'L ltir .-J 0 . e0 J-iY—a:?C;
2. Smile q,) Q,JHE
Car,,racto,
3.
A.r"iroaer __.__......_ ... _
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 ail applicable lows of this ' urisdiction.
Signature of applicant Address i APptication dote
DO NOT WRITE BELOW THIS LINE
V. PLAN REVIEW RECORD — For office use
Date
Plan Review
Plans Re Required Check Fee
Started I By Date Plans
Approved By Non
BUILDING S
PLUMBING
MECHANICAL S
ELECTRICAL
OTHER S
VI, ADDITIONAL PERMITS REQUIRED OR OTHER JURISDICTION APPROVALS
Date pale
Permit or Approval Check Obtained Number By Permit or Approval Check Obo ed 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
Permit number ____ ss-0 _..�—
Building
Permit issued . / ;_ 1972—
Building
Permit Fee $ I0Ot7
Certificate of Occupancy S— .._ -
Approved by:
Drain Tie $ _
Pion Review Fee S
TITLE
NOTES and Data — !For department use)
VIII. ZONING PLAN EXAMINERS NOTES '
DISTRICT _... -
USE
FRONT YARD
SIDE YARD SIDE YARD
REAR YARD ....
NOTES
IX. SITE OR PLOT PLAN — For AppL<ant Use 4
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