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IDENTIFICATION — To be completed by all applicants Name Mailing address — Number, street, city, and State ZIP code Tel. No. i. S g ��r�o� �� lQren,� 1`164 �IC7t?() S�6 7561 Owner or - �' •�" Lessee ` 2. �XY�/ I � I �r`(l/Ot/l/� Sl (� 110k, N( Builder's �� C� License No. 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. Signature of applicant Address Application date 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 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 f / Building Use Group Permit issued . "�Mi 19 Building Fire Grading Permit Fee $ /C� %� Live Loading Certificate of Occupancy $ Occupancy Load Approved Drain Tile $ Plan Review Fee $ TITLE CITY OF NORTHAMPTON �. .� MASSACHUSETTS OFFICE of the INSPECTOR of BUILDINGS Page / Plot 23 APPLICATION FOR INSPECTOR ZONING PERMIT AND BUILDING PERMIT z IMPORTANT — Applicant to complete all items in sections: 1, 11, 111, IV, and IX. 0 r t ZONING I• AT (LOCATION) T7 k �� DISTRICT LOCATION (N0.) (STREET) OF BETWEEN _AND BUILDING CROSS STREET) (CROSS STREET) LOT SUBDIVISION LOT_ BLOCK SIZE fJf II. TYPE AND COST OF BUILDING — All applicants complete Parts A — D ;a A. TYPE OF IMPROVEMENT D. PROPOSED USE — For"Wrecking" most recent use rn rn 1 [:] New building Residential Nonresidential 2 Addition(1/ residential, enter number 12 ® One family 18 Amusement, recreational of new bousing units added, if any, in Part D, 13) 13 F-1 Two or more family - Fnter 19 n 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 - F_nter number 5 E] Wrecking (1l multi family 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 E Moving (relocation) 17 Other - Speci/y 25 Public utility 70 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 at hospital, elementary 10. Cost of improvement,,,,,,,,,,,,,,,, -7�C 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 I- a. Electrical..................... ! ^ i b. Plumbing ..................... / I r 1� /. i c. Heating, air conditioning.......... r d. Other(elevator, etc.)............. f 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❑ 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 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 Yes 45 No 53. Number of bedrooms.............. 38 Coal 39 Other - .Specify Will there be an elevator? Full.......... 54. Number of 46 [ � Yes 47 'D No bathrooms Partial........ s a t,� OF BUILDING INSPECTIONS BUILDING Z° � 212 Main Street f - a Northampton, MA 01060 PERMIT < 29 -73 VALIDATION DATE DecQwb er 20 19 22 PERMIT NO. 71q9 APPLICANT E ie_Raffles ADDRESS4IQ dHlxl�r (N0.) R ) (CONTR'S LICENSEI PERMIT TO Alteration (_) STORY One Family DWELLING UNITS (TYPE OF IMPROVEMENT) NO. (PROPOSED USE) AT (LOCATION) 38 Acrebrook Drive ZONING CT URA DISTR (NO.) (STREET) BETWEEN AND_ (CROSS STREET) (CROSS STREETI 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 the installation of a sliding cilass door in kitchen area AREA VOLUME ESTIMATED COST $ 500.00 FEEMIT $ 10.00 (CUBIC/SQUARE FEr T) OWNER Elaine Ramos & Arm o Souza ,VV/' (`'- ) A ADDRESS 38 Acrebrook Dr. , Florence Bvl`D { TM""�'' '1 " WHITE - FILE COPY . GREEN - FIELD COPY ■ CANARY - APPLICANT COPY • PINK - ASSESSORS COPY pjNT P