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NOTES and Data — (For department use)
IV. IDENTIFICATION — To be completed by all applicants
Name Mailing address — Number, stmt, city, and State ZIP code Tel. No.
1 ? p
1 /C)L o
Owner or. ��� lit"
Lessee
Builder's
2.
License No.
Contractor
�
ate'` .r .^,✓i' J..b%'e'+� Z..sL.?a? FN�- TJ L 5�S
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 j Apppllicattion date
00 NOT WRITE BELOW T S LINE
V. 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
Date D
Permit or Approval Check Obtained Number By Permit or Approval Check Obtta t 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 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
Ap ove by:
Drain Tile $ `
Plan Review Fee $
TITLE
CITY OF NORTHAMPTON
MASSACHUSETTS
r r
$ OFFICE of the INSPECTOR of BUILDINGS
qy
�uST Page— — Plot 3s l(O Ci APPLICATION FOR
INSPECTOR ZONING PERMIT AND
BUILDING PERMIT
IMPORTANT - Applicant to complete all items in sections: 1, 11, 111, IV, and IX. o
/,� lF ZONING
I• AT (LOCATION) y Li ��Y \��'elvl DISTRICT �I
LOCATION (NO.) TREET)
OF BETWEEN AND
BUILDING (CROSS STREET) (CROSS STREET)
LOT
SUBDIVISION LOT BLOCK SIZE
V1
11. TYPE AND COST OF BUILDING - All applicants complete Parts A - D -�
A. TYPE OF IMPROVEMENT D. PROPOSED USE — For"Wrecking" most recent use m
M
1 ❑ New building Residential Nonresidential
2 ❑ Addition(IJ residential, enter number 12 One family 18 ❑ Amusement, recreational
of new housing units added, if any,
in Part D, 13) 13n Two or more family — Enter 19 ❑ Church, other religious
number of units— — — — -.1p. 20❑ Industrial
3 Alteration (See 2 above) 14 ❑ Transient hotel, motel,
21 ❑ Parking garage
4❑ Repair, replacement or dormitory — Enter number
❑ o units ——————— — --0. 22 ❑ Service station, repair garage
5 Wrecking (I/multifamily residential, f
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'- SpecifyD 25 ❑ Public utility
7 ❑ Foundation only ff�. ���_�/� 26❑ School, library, other educational
B. OWNERSHIP �'� ^"'� d' �^�+' 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•••••••••••••••• CIO 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 ptopoged 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❑ Masonry (wall bearing) 40 [7] Public or private company 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 0 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 1. TYPE OF MECHANICAL 51. Enclosed .......................
35 ❑ Gas Will there be central air 52. Outdoors........................
36 Oil conditioning?
L. RESIDENTIAL BUILDINGS ONLY
37 j 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 [�j No bathrooms Partial........
y DEPT. OF BUILDING INSPECTIONS gUILD1NG �° 1 l0 1 ce�
2Al2 Main Street '<
Northampton, MA 01060 PERMIT
35 - 164 VALIDATION
DATE May 7„t9** 85 P 1 �; 238
APPLICANT Albert Omasta ADDRESS 40 olV�a' , --- 'Tie 2
(NO.) (STREET) (CONTR'S LICENSE)
PERMIT TO Addition (_) STORY One Family NUMBER OF
DWELLING UNITS
(TYPE OF IMPROVEMENT) NO. (PROPOSED USE)
AT (LOCATION) 809 Ryan Road ZONING
(NO.) (STREET) DISTRICT
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 the addition of a second floor
AREA VOLUME ESTIMATED COST $ 18,000.00 PERMIT 76.00
(CUBIC/SQUARE FEET)
OWNER David Klimczak
ADDRESS 809 Ryan Road, Northampton, Mass. 01060 BUILD
WHITE - FILE COPY . GREEN - FIELD COPY • CANARY - APPLICANT COPY • PINK - ASSESSORS COPY P'iRT' P