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NOTES and Data — (For deportment use)
IV. IDENTIFICATION — To be completed by all applicants
Nome Mailing address — Number, street, city, and .State ZIP code Tel. No.
Owner or
Lessee
Builder's --7(
2. �� "4 License No. a V
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 jurisdiction.
Signat a pplic Address Application date
00 NOT WRITE BE (0 W THIS LINE
PLAN REVIEW RECORD — For office use
Plans Review Required Check Plan Review Date Plans B Date Plans B Notes
q Fee Started y Approved y
BUILDING $
PLUMBING $
MECHANICAL $
ELECTRICAL $
OTHER $
VI. ADDITIONAL PERMITS REQUIRED OR OTHER JURISDICTION APPROVALS
Permit or Approval Check Obttaired 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 FOR DEPARTMENT USE ONLY
Permit number
Bui Iding. s Use Group
Permit issued � � �� 19
Building
Fire Grading
Permit Fee Live Loading
Certificate of Occupancy $ Occupancy Load
Approved by:
Drain Tile
Plan Review Fee $
TITLE
CITY OF NORTHAMPTON
�• MASSACHUSETTS
$ e OFFICE of the INSPECTOR of BUILDINGS
Page Plot _ APPLICATION FOR
INSPECTOR ZONING PERMIT AND
BUILDING PERMIT
IMPORTANT — Applicant to complete all items in sections: 1, 11, 111, IV, and IX. O
"�
K/JJ ZONING
I• AT (LOCATION) .2 7 E/1/1���0� t 1(� DISTRICT
LOCATION (NO.) (ST EET)
OF BETWEEN &(042V W66A 1) [r, AND �t°CC�EkA
BUILDING (CROSS STREET) (CROSS STREET)
LOT
SUBDIVISION LOT BLOCK SIZE X00 X 1a�
N
II. TYPE AND COST OF BUILDING — All applicants complete Parts A — D -a
X
A. TYPE OF IMPROVEMENT D. PROPOSED USE - For"Wrecking" most recent use m
M
1 ❑ New building Residential Nonresidential
2[WAddition(If residential, enter number 12 ❑ One family 18 ❑ Amusement, recreational
of new bousing units added, if any,
in Part D, 13) 13 ❑ Two or more fomily - Enter 19 ❑ Church, other religious
number of units- - - - -� 20 ❑ Industrial
3 ❑ Alteration (See 2 above) 14 ❑ Transient hotel, motel,
21 ❑ Parking garage
4 ❑ Repair, replacement or dormitory - Enter number
5 ❑ Wrecking (It multifamily residential, f units ------- - -ta 22 ❑ Service station, repair garage
enter number of units in building in 15 �arage 23 ❑ Hospital, institutional
Part D, 13)
6 ❑ Moving (relocation) 16 Carport 24 ❑ Office, bank, professional
7 ❑ Foundation only 17[: Other - Specify geJydf) nn 4'-' 25 ❑ Public utility
26 ❑ School, library, other educational
B. OWNE HIP I,� 27 ❑ Stores, mercantile
8 Private (individual, corporation, 26 ❑ 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,,•,,••,•,,,,,,, S g 00 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..................... 700, —
b. Plumbing ....................... /0001
c. Heating, air conditioning.........
d. Other (elevator, etc.)............
11. TOTAL COST OF IMPROVEMENT $ /0,00.0s
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 WAGE DISPOSAL J. DIMENSIONS
30❑M onry (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_jU
32 F-1 Structural steel dimensions ..................... 7
33 ❑ Reinforced concrete H. TYPE SUPPLY
50. Total land area, sq. ft. ...........
34 ❑Other - Specify 42 or private company
43 ❑ Private (well, cistern) K. NUMBER OF OFF-STREET
PARKING SPACES
F. PRINCIPAL TYPE OF HEATING FUEL I. TYPE OF MECHANICAL 51. Enclosed .......................
35 `%,, Gas Will there be central air 52. Outdoors........................
36 Oil conditioning?
L. RESIDENTIAL BUILDINGS ONLY
37 Electricity 44 es No
❑ Y 45 -- 53. Number of bedrooms..............
38 Coo 1
39 n Other - .Specify Will there be an elevators Full.......... /
54. Number of
46 n Yes 47 & No bathrooms Partial........
6F BUILDING INSPECTIONS BUILDING Z°
212 Main Street 0<
Northampton, MA 01060 PERMIT
29 - 434 VALIDATION
John Dziubek DATE AuEUSt 27 �9E_8OnPkaMIT NO. 506 4
APPLICANT ADDRESS g
(N0.) (STREET) (CONTR'S LICENSE)
PERMIT TO Addition (_) STORY Bedroom & Bath NUMBER OF
DWELLING UNITS
(TYPE OF IMPROVEMENT) NO. (PROPOSED USE)
AT (LOCATION) 27 Ellington Road DISTR CT
(NO.) (STREET)
BETWEEN AND
(CROSS STREET) (CROSS STREET)
LOT
SUBDIVISION LOT BLOCK SIZE
BUILDING IS TO BE FT. WIDE BY FT. LONG BY FT. IN HEIGHT AND SHALL CONFORM IN CONSTRUCTION
TO TYPE USE GROUP BASEMENT WALLS OR FOUNDATION
(TYPE)
REMARKS: permit for an addition of a bedroom and bath
AREA
VOLUME 345 SCI. ft. ESTIMATED COST � 101wo.00s FEE
MIT 36.00
(CUBIC/SQUARE FEET)
OWNER Same AS Applicant
Same as A icant s BUILDI
ADDRESS pp BY
WHITE - FILE COPY . GREEN - FIELD COPY ■ CANARY - APPLICANT COPY ■ PINK - ASSESSORS COPY pjNT' liP