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NZ N�n■marsh■•.• masseuse OR 11 0 .I �1 • � a ! ¢■ �• •• .fir. �•i ■ a .■nruiiii Ni8, III: 11t �• • N tour ■ • � r •sw �� •r N • ■ .11.•11.11 r ■ ■. w ■. r. r r i i■ 3 tnn it Go iiii1,i n/ oammus Na MIN�� � • • �• • ■ a■ . a.aw. ut R. • R ate• �awsawRNaunral an 11 NN ■N N t r sr�• as as • �i � l��i�i�i•uZ•i n u ! N Nr u •.N wul HIRE■ ■ it s �!��saiis �•a�ii� ■ � ■ ! ■r •or i i Rome =I �r Runs!I l r • r p r n iii ■ ■1�. ii`.i`■,\r� aGii R • • 1.■�*q�rli N .... .r NOTES and Data — (For department use) IV. IDENTIFICATION — To be completed by all applicants Name Mailing address — Number, strcct, citx, and .Ctrrtc ZIP code Tel. No. Owner or Lessee L. Bui Ider's License No. 3. Contractor 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 D0 NOT WRITE BELOW THIS LINE V. PLAN REVIEW RECORD — For office use Plans Review Required Check Plan Review Date Plans Date Plans Fee Started By Approved BY Notes BUILDING PLUMBING MECHANICAL ELECTRICAL OTHER VI. ADDITIONAL PERMITS REQUIRED OR OTHER JURISDICTION APPROVALS Permit or Approval Check Obtained Date Number By PP Permit or Approval Check Obttait ed 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 Permit number _ Building Permit issued lq Building Permit Fee Certificate of Occupancy Ap Drain Tile a,, d by: � Plan Review Fee S— TITLE o " Cri tp of Xort4ampton &58eTt))1TSPt1:8 ` Office of the �naptrtur of Touilbings APPLICATION FOR PERMIT Page_ Plot_ ZONING BUILDING PE MITD IMPORTANT — Applicant to complete all items in sections: 1, 11, 111, IV, and IX. p ZONING I• AT (LOCATION) W ( .-Vn,Q �/� DISTRICT LOCATION (Nb.) (STREET)' OF BETWEEN AND BUILDING (CROSS STREET) (CROSS STREET) LOT SUBDIVISION LOT BLOCK SIZE II. TYPE AND COST OF BUILDING — All applicants complete Parts A — D A. TYPE OF IMPROVEMENT D. PROPOSED USE - For"Wrecking" most recent use M 1 ❑ New building Residential Nonresidential 2 ❑ 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 ❑ 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 (if multifamily residential, of units ------- - --s 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 X Other - Specify 25 ❑ Public utility 7 ❑ Foundation only _ 26 ❑ School, library, other educational B. OWNERSHIP 27 ❑ Stores, mercantile 8 ❑ Private (individual, corporation, 28 ❑ 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 of 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.)............ •— T 11. TOTAL COST OF I RO S '(> ' Ill. 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. D, E. PRINCIPAL TYPE OF FRAME G. TYPE OF SEWAGE DISPOSAL J. DIMENSIONS O m 30❑Masonry (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 - Specify 42 F-1 Public or private company 50. Total land ores, sq. ft. ........... 43 ❑ Private (well, cistern) K. NUMBER OF OFF-STREET PARKING SPACES 51. Enclosed ...................... r F. PRINCIPAL TYPE OF HEATING FUEL I. TYPE OF MECHANICAL O 35 ❑ Gas Will there be central air 52. Outdoors........................ 36 ❑ Oil conditioning? L. RESIDENTIAL BUILDINGS ONLY 37 ❑ Electricity 44❑ Yes 45 ❑ No 53. Number of bedrooms.............. 38 ❑ Coal 39 ❑ Other - Specify Will there be an elevator? 54. Number of Full.......... 46 ❑ Yes 47 ❑ No bathrooms Partial....... MW I hereby certify that the proposed work is authorized by the owner of record and I have been authorized by the owner to make thi-sppjication. as his authorized agent. SIGNATURE OF AGENT ADDRESS _ (NUMBER) (STREET) (CITY) APPROVED BY TITLE DATE 19 Zo DEPT. FILE COPY CITY OF N©RTI MPT�JN BUILDING as NORTHAMPTON, K4SS. 01060 PERMIT VALIDATION GATE An 1G 19. 1977 PERMIT NO. 3.72 APPLICANT Thomas Btinna.l1 ADDRESS 128 Was Farmia Road (NO.) (STREET) (CONTR'S LICENSE) NUMBER OF PERMIT TO 'ga= Damoli j jon (�) STORY TZgMnjiUan DWELLING UNITS (TYPE OF IMPROVEMENT) NO. (PROPOSED USE) AT (LOCATION) 1 28 WAsRt T1tiaxmR j nad ZONING R DISTRICT (NO.) (STREET) a BETWEEN AND (CROSS STREET) (CROSS STREET) LOT D SUBDIVISION LOT BLOCK SIZE m a V O. BUILDING IS TO BE FT. WIDE BY FT. LONG BY FT. IN HEIGHT AND SHALL CONFORM IN CONSTRUCTION (D O Z TO TYPE USE GROUP BASEMENT WALLS OR FOUNDATION f (TYPE) It IL REMARKS: Rare damnli+inn AREA OR PERMIT VOLUME ESTIMATED COST . I r,00 00 FEE $ lo-o0 (CUBIC/SQUARE FEET) OWNER Thomas RL1czala �Am� ADDRESS 128 Went, Parmc Road (Affidavit on reverse side of application to be completed by authorized a ent of owner)