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59
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g/��� PERMIT NO. S S
APPLICAM ADDRESS 0 �Imo.1 �y IbTRf 1 (BRATS'S L¢ENsEI
NUMBER (0
PERMIT TO I I STONY DWELLING UNITS
(TYPE OF IMMP}ROY£MENTI NO. (PRGPOA0 USE}
AT (LOCATION) e e CU-liz-± -meq• ING
-DISTRICT
(RO.1 (STREET)
BETWEEN AND
y' (CROSS STREET( (CROSS STAEET)
LOT
m▪ SUBOrvISION LOT BLOCK_ SIZE
rt
0
O SUILOING IS TO BE FT. WIDE BY FT. LONG BY FT. IN HEIGHT AND SHALL CONFORM IN CONSTRUCTION
Y
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E
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AREA OR f. 3 � _, PERMIT p to TO L
VOLUME ESTIMATED COST $ FEE $
H--�'"✓ ICUI [/N`Pu4RE'P¢fTl (�
OWNER
A66RESE49-1 � IT 8
(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 of record '
and I have been authorized by the owner to make this application as his
authorized agent.
SIGNATURE OF AGENT
ADDRESS
(NUMBER) (STREET) (CITY)
APPROVED BY TITLE
DATE 19,.
FOSS'NO.SOCA AP 0150 �7tw1
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CITY OF NORTHAMPTON
OFFICE OF THE INSPECTOR OF BUILDINGS
212 MAIN STREET APPLICATION FOR
NORTHAMPTON, MA. 01060 r3 — 6q PLAN EXAMINATION AND
/ BUILDING PERMIT
IMPORTANT — Applicant to complete all items in sections: I, II, III, IV, and IL O
AT (LOCATION) V QUNPhy 1)1 /1/p AM 41 DISTRICTSR
LOCATION 1No (STREET'
OF BETWEEN AND
BUILDING )CROSS STREET) (CROSS STREET)
LOT
SUBDIVISION LOT BLOCK SIZE
U,
II. TYPE AND COST OF BUILDING — All applicants complete Parts A — D
0
A. TYPE OF IMPROVEMENT D. PROPOSED USE — For"Wrecking" most recent use rn
m
1 I/Addition
building Residential�� Nonresidential —1
Addition(I/residential, enter number 121v1 r,ne family 181 I Amusement, recreational
ofnew housing units added, if any, 13 Two or more family - Enter 19 Church, other religious
Pmt D, 13)
number of units— — — — y 20 I I Industrial
3 I I Alteration (See 2 above) 14 I I Transient hotel, motel, 21 Pi Parking garage
41 I Repair, replacement or dormitory — Enter number
5 1 I Wrecking (If multifamily residential, of units —y 22 I I Service station, repair garage
enter number of units in building in 15 I I Garage 23 I I Hospital, institutional
Part 0, 13)
6 Moving (relocation) 161 I Carport 24 I I Office, bank, Professional
> Foundation only 17 Fl Other — Specify 25 I I Public utility
26 Li School, library, other educational
8. OWNERSHIP /NSrItr /V2 41 Chan.2.1 27 1 ( Stores, mercantile
8 I I Private (individual, corporation, ) // 281 Tanks, towers
nonprofit institution,etc.) /`/y( 'yew wan 4Ji x/i,V=l 29 1 Other — Specify
9 LL Public (Federal, State, or ✓
local government) irtif
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 $ ,QSc[J. 2TT school, secondary school, college, parochial school, parking garage for
departmentstore, 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 L3422;Uar
III. SELECTED CHARACTERISTICS OF BUILDING — For new buildings and additions, complete Ports 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. DIMENSIONS48
30 L l Masonry (wall bearing) 401 ✓ Public or pri vete companyNumber of stories
31 vl Wood frame 41 Private (septic tank, arc) 49. Total square Feet of floor area,
all floors, based on exterior
32 1 Structural steel dimensions
331 I Reinforced concrete H. TYPE OF WATER SUPPLY
341 I Other — Specify 42PEPublic or private company 50. Total land area, sq. ft
1 Rl
431_J Private(well, cistern) K. NUMBER OF OFF-STREET
PARKING SPACES
F. PRINCIPAL TYPE OF HEATING FUEL I. -E OF MECHANICAL SL Enclosed
35 I Gas Will th. - be central air 52. Outdoors
361 ( Oil conditioning:
L. RESIDENTIAL BUILDINGS ONLY
37 I /Electricity 44I Yes ' 1 No 53. Number of bedrooms
313 I I Coal
39( Other— Specify Will t. e be an elevator? 1 Full
54. Number of
1 1 Yes 47 I No bathrooms
Partial./
NOTES and Data — (For department use)
AV. IDENTIFICATION - To be completed by all applicants
Name Mailing address — Numbor, street, city, and Ram ZIP code Tel. No.
D.. er ar - -
Lessee if
Bu,de s
2. 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 'um sdiction.
S ignatr of appl con Address Application date
47/44:12,29 /dir< � h�� ilaUfayy 9/2
DO NOT WRITE BELOW THIS LINE
V. PLAN REVIEW RECORD — For office use
Plans Review Required Check Plan Review Date Plans Date Plans ByNotes
p uirB Fee StartedBy Approved
BUILDING $
PLUMBING $
MECHANICAL $ ,
ELECTRICAL $
OTHER $
VI. ADDITIONAL PERMITS REQUIRED OR OTHER JURISDICTION APPROVALS
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
Buildingiia FOR DEPARTMENT USE ONLY
Permit number T
BuildingQ Use Group
Permit issued ( I 197?
Building Fire eroding
Permit Fee $ I° Oen Live Loading
Certificate of Occupancy $ Occupancy Load
App by:
Drain Tile $ \ \
Plan Review Fee $ J
TITLE
VIII. ZONING PLAN EXAMINERS NOTES
DISTRICT
USE
FRONT YARD
SIDE YARD SIDE YARD
REAR YARD
NOTES
IX. SITE OR PLOT PLAN - For Applicant
Use .""' _ "1 �fr'-C4.I
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GPC I,FORM BPEBP - 669 01969 BUILDING DFFIClav9 8 LDDC LDmix1Y1'a Yfons INIE$NA UONAL, IMm