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IDENTIFICATION — To be completed by all applicants Name Mailing address — Number, stmt, city, and State ZIP code Tel. No, Owner or o t- . C'9 � r Y Lessee Lfr Cl T © 0 o Builder's 2. License No. Contractor U 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. Sign re of applicant Address Application date :!�,,qlV 7- 57 1 e,v 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 Permit or Approval Check Date Number By Permit or Approval Check Date Number B Obtained Obtained 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 FOR DEPARTMENT USE ONLY Permit number z`A Building +> 19 1- Use Group Permit issued Building Fire Grading Permit Fee $ Live Loading Certificate of Occupancy Occupancy Load Approved by: Drain Tile $ '� Plan Review Fee $ rA "i t ,1111 r� CITY OF NORTHAMPTON MASSACHUSETTS $ OFFICE of the INSPECTOR of BcUUI)LDINGS �u r Page Plot / Cam! APPLICATION FOR INSPECTOR ZONING PERMIT AND BUILDING PERMIT z IMPORTANT — Applicant to complete all items in sections: I, II, Ill, IV, and IX. O ZING I• AT (LOCATION) 366 //{6EA5,4A l r '� DIOSTR CT.r LOCATION (140.) (STREET) OF BETWEEN AND BUILDING CROSS STREET) CROSS STREET) LOT SUBDIVISION LOT BLOCK SIZE rf II. TYPE AND COST OF BUILDING — All applicants complete Parts A — D X A. TYPE OF IMPROVEMENT D. PROPOSED USE — For"Wrecking" most recent use M m 1 F] New building Residential Nonresidential 21::] Addition(If residential, enter number 12❑ One family 18 Amusement, recreational of new housing units added, if any, �• in Part D, 13) 13 Two or more family — Enter 19 n Church, other religious 3 0 Alteration (See 2 above) number of units— — —- --) 20 Industrial 14 Transient hotel, motel, 21 Parking garage 4 .Repair, replacement or dormitory — Enter number 5 ❑ Wrecking (If multifamily residential, of units ——————— — --i 22 �� Service station, repair garage enter number of units in building in 15 Garage 23 Hospital, institutional Part D, 13) 16 Carport 24 n Office, bank, professional 6 Moving (relocation) 17 Other — Speci/y 25 Public utility 7 Foundation only 26 School, library, other educational B. OWNERSHIP 27 Stores, mercantile 8 >< Private (individual, corporation, 28 n Tanks, towers nonprofit institution, etc.) 29 Other — Specify 9 L7 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. 7o 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 (wievaia , tc.)............. Jd� 11. TOTAL COST OF IMPROVEMENT Is 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 n 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 Will there be central air 52. Outdoors........................ 36 Oil conditloning7 L. RESIDENTIAL BUILDINGS ONLY 37 CJ Electricity 44 [_] Yes 45 No 53. Number of bedrooms.............. 38 Coal 39 Other — Specify Will there be an elevatory Full.......... - 54. Number of 46 1 Yes 47 �:] No bathrooms Partial....... ry 6 O N .�i o � a ea a+ ca W W o = � •''•' oc c � � F •c ,� A L •p �i LTr C '� V � � y O w w a a .., N M Z Z c L H 8 E Q- ¢• ° o W on co °O C14 04 ono r.0.0 0-00 0-- r-Cr rCi rCi tj v p v •C CC L O �i > V i Poo 4. C r-q O L O V a• C p Z o H Q O i V O b in .0 ++ 0. ^r G U 0. y as m e O a.J C CC ++ V O .° Q" A 4-4 co ej rl N V ° V C O> d co r-I `n C C Qj C F pa N O L �+•+ � O V V }4 O G E cd 4e.ei►•� Z F .c 'v� a v, (M «r c E Z