32C-113 (9) IV. IDENTIFICATION — To be completed by all applicants
Name Mailing address — Number, street, city, and State ZIP code Tel. No.
Owner or ,V3 ;fd".v q / C/ N s 7—/Vu T -s7. °"-e /— C /G' 3-25'3 '/
Lessee tsy
Builder's
2. .54 /�N/`/A !' License No.
Contractor l�
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 applicannt / Adddress� �L �1 Application date
C 4?/i"-u L1/'✓ 9/ -./2/ 1 /T� //L/� "mac i S/0-L7/27-e,
DO 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
Approval Check Date Number Permit Approval Check Date
Permit or A umer
PP Nbe B Obtained By Perit or A PP l Number By
y
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 FOR DEPARTMENT USE ONLY
Permit number
Building Use Group
Permit issued A/9kFire Grading
Bui lding
Permit Fee $ 741 a ® Live Loading
Occupancy Load
Certificate of Occupancy $
Approved by:
Drain Tile $
J
Plan Review Fee $ �� ij
.rte
F-T-LE
NOTES and Data — (For department use) ` ..
`i0 PAt r 7 o 6 a LC14/1/, f oJ'
//a I O o M /FA/rL i /9,41"- ?- far SP�/f'
3 C //3
•
CITY OF NORTHAMPTON
OFFICE OF THE INSPECTOR OF BUILDINGS
212 MAIN STREET APPLICATION FOR
NORTHAMPTON, MA. 01060 PLAN EXAMINATION AND
BUILDING PERMIT
z
IMPORTANNTR— Applicant to complete all items in sections: I, II, Ill, IV, and IX. ,per o ZONING I. AT (LOCATION) v / C°'N �/ r DISTRICT U/rim
LOCATION (No. (STREET)
OF BETWEEN AND
BUILDING (CROSS STREET) (CROSS STREET)
LOT
SUBDIVISION LOT BLOCK SIZE
V1
II. TYPE AND COST OF BUILDING — All applicants complete Parts A — D —I
x
A. TYPE OF IMPROVEMENT D. PROPOSED USE — For"Wrecking" most recent use Tn
M
—I
1 I New building Residential Nonresidential
2 I I Addition(If residential, enter number 121 I One family 18 Amusement, recreational
of new housing units added, if any,
in art D, 13) 13 i Two or more family — Enter 19 Church, other religious
number of units— — — — --0- 20 Industrial
3 L,111 Alteration (See 2 above)
14 I I Transient hotel, motel, 21 Parking garage
4 I I Repair, replacement or dormitory — Enter number 22 Service station, repair garage
5 I I Wrecking (If multifamily residential, of units —
enter number of units in building in 15 I Garage 23 Hospital, institutional
Part D, 13)
16 I I Carport 24 Office, bank, professional
6 I I Moving (relocation)
17 WrCther — Specify 25 Public utility
7 rI Foundation only
26 School, library, other educational
B. OWNER HIP 27 Stores, mercantile
8 I Private (individual, corporation, 28 Tanks, towers
nonprofit institution, etc.) 29 I Other — Specify.SW4WRO 0/)/fl
9 1 I Public (Federal, State, or S/t/tOG�
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 $ G(J,.Q7 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 $
s'C00 ---
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. PRINCIP TYPE OF FRAME G. TYPE OF SEWAGE DISPOSAL J. DIMENSIONS
30 Masonry (wall bearing) 40 I I Public or private company Number of stories
31 I I Wood frame 41 I I Private (septic tank, etc.) 49. Total square feet of floor area,
all floors, based on exterior
32 I I Structural steel dimensions 9794P
33 I I Reinforced concrete H. TYPE OF WATER SUPPLY
34 I- I Other — Specify 42 I I Public or private company 50. Total land area, sq. ft. /)j/r6'0
43 I I Private(well, cistern) K. NUMBER OF OFF-STREET •!
PARKING SPACES
F. PRINCIPAL TYPE OF HEATING FUEL I. TYPE OF MECHANICAL 51, Enclosed
35 I Gas Will there be central air 52. Outdoors /0
36 I I Oil conditioning? L. RESIDENTIAL BUILDINGS ONLY
37 I I Electricity 44 I I Yes 45 I I No 53. Number of bedrooms
38 I I Coal
39 Other — Specify 1.1/00d Will there be an elevator? Full
54. Number of
46 I I Yes 47 I I No bathrooms
Partial
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