32C-316 (2) ZONING •
FRONT DISTRICT
USE
SIDE YARD
SIDE YARD
REAR YARD
NOTES
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NOTES and Data — (For department use)
IV. IDENTIFICATION — To be completed by all applicants a 4.
Name Mailing address — Number, stmt, city, and State ZIP code Tel. No.
Owner or TLh
Lessee
Bu,Ider's
YM D`Z. License No.
Contractor
3. v
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 applicant Address Application date
00 NOT WRITE BELOW THIS LINE
V. PLAN REVIEW RECORD — For office use
Plan Review Date Plans Date Plans
Plans Review Required Check Fee Started By Approved BY Notes
BUILDING $
PLUMBING $
MECHANICAL $
ELECTRICAL $
OTHER $
VI. ADDITIONAL PERMITS REQUIRED OR OTHER JURISDICTION APPROVALS
Date Date
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
Building FOR DEPARTMENT USE ONLY
Permit number
Building- y ,2 Use Group
19
Permit issued \
Building Fire Grading
Permit Fee $ (V Live Loading
Certificate of Occupancy $ Occupancy Load
ro d by
Drain Tile $ "
Plan Review Fee $
TITLE
CITY OF NORTHAMPTON
MASSACHUSETTS
OFFICE of the INSPECTOR of BUILDINGS
Page 3-.2-c- Plot �jU APPLICATION FOR
INSPECTOR ZONING PERMIT AND
BUILDING PERMIT
IMPORTANT/�- Applicant to complete all items in sections: 1, 11, 111, IV, and IX. O
ING
I• AT (LOCATION) zqke '�`��• / '.. � - DIOSTR CT�
LOCATION STREET' '
OF BETWEEN AND
BUILDING (CROSS STREET) (CROSS STREET)
LOT
SUBDIVISION LOT BLOCK SIZE
IL TYPE AND COST OF BUILDING - All applicants complete Parts A - D
A. TYPE OF IMPROVEMENT D. PROPOSED USE - For"Wrecking" most recent use r^
M
1 ❑ New building Residential Nonresidential
2 El Addition(1 residential, enter number
J 12 One family 18 ❑ Amusement, recreational
of new bousing units added, if any,
in Part D, 13) 13 Two or more family — Enter 19 ❑ Church, other religious
number of units— — — — —� 20 Industrial
3 F-1 Alteration (See 2 above) 14 ❑ Transient hotel, motel, ❑
4 ❑ Repair, replacement 21 ❑ Parking garage
P F or dormitory — Enter number
5 ❑ Wrecking (1f multifamily residential, of units ——————— — -- 22 ❑ Service station, repair garage
enter number of units in building in 15 ❑ Garage 23 ❑ Hospital, institutional
Part D, 13)
16 ❑ Carport 24 ❑ Office, bank, professional
6 ❑ Moving (relocation)
17❑ Other — SpeciJy 25 ❑ Public utility
7 ❑ Foundation only �� �J�,, 26 ❑ School, library, other educational
B. OWNERSHIP "n�'`�""`� 27 ❑ Stores, mercantile
❑8 � Private (individual, corporation, 28 Tanks, towers,may
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,,,,,,,,,,,,,,,, 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
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❑ Masonr y (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
32 Structural steel dimensions .
33 ❑ Reinforced concrete H. TYPE OF WATER SUPPLY
34 ❑ Other — SpeciJy 42 ❑ Public or private company
50. Total land area, sq. ft. ...........
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 Y 45 ❑ No
❑ es -- 53. Number of bedrooms..............
38 ❑ Coal
39 ❑ Other — Specify Will there be an elevator" Full..........
54. Number of
46 ❑J Yes 47 ❑ No bathrooms Partial........
� , ,a.,
a
Depar-tmen of Building Inspections
212 Main Street BUILDING o° d `
Northampton, Ma. 0100 PERMIT a
32C • 316 VALIDATION
DATE June 16, 19 82 PERMIT NO. 266
APPLICANT Hei zy Kubasi ek ADDRESS 1'Ajj tnil Lirarkina_ 262 roles Me,�],p�� Rrl•
(N0.) (STREE (CONTR'S LICENSE)
NUMBER OF
PERMIT TO W P_Ckinc STORY RArn DWELLING UNITS
(TYPE OF IM ROVEMENT) NO. (PROPOSED USE)
ZONING 40 AT (LOCATION) Hp-nry DISTRICT URC
(NO.) (STR ET)
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: I)melitieg, of existing be=
PERMIT
AREA OR
VOLUME ESTIMATED COST $_ ion-on FEE 10.00
(CUBIC/SQUARE FEET) °
OWNER Helen Slesinski BUILDING��€ ,L^
ADDRESS 40 Henry St-, Northampton, Ma. 01060 BY
WHITE - FILE COPY . GREEN - FIELD COPY • CANARY - APPLICANT COPY PINK - AS SSORS COPY