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NOTES and Data — (For deportment use)
s7
�,E� � I f
rl
IS
4177- 7-3)
IV. IDENTIFICATION — To be completed by all applicants
Name Mailing address — Number, street, rrty, arui State ZI.P,**code Tel. No.
Owner or
Lessee
2. � 1> 1, { �� 77"e;f�f` A ,r x ?° ,r a :, License er No. c� 415S
Contractor L '
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
'' � �✓'i"...-�-tee t�'' r' �': l;�',.� ,�{as�
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
II. VALIDATION
Building c, FOR DEPARTMENT USE ONLY
Permit number
Bur(ding. !�7� J 1 ,1 %7 19 Use Group
Permit issued L'/' a%LL/_y✓L`�
Building to, 0 o Fire Grading
Permit Fee $ L
Live Loading
Certificate of Occupancy $ Occupancy Load
ved by:
Drain Tile $ 1111c,
Plan Review Fee $
TITLE
CITY OF NORTHAMPTON
�• .� MASSACHUSETTS
$ OFFICE of the INSPECTOR of BUILDINGS
� T
a Page Plot APPLICATION FOR
INSPECTOR ZONING PERMIT AND
BUILDING PERMIT
IMPORTANT — Applicant to complete all items in sections: I, I1, 111, IV, and IX. O
ZONING
I• AT (LOCATION) `.�I `""� `7J�' � "e + DISTRICTS
LOCATION (N0.) (STREET)
OF BETWEEN AND
BUILDING (CROSS STREET) (CROSS STREET)
LOT
SUBDIVISION LOT BLOCK SIZE
Vr
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
M
1 ❑ New building Residential Nonresidential
2 [9 Addition(If residential, enter number 12 ZOne 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 ransent hotel, mote ,
❑ T i htl l 21 ❑ Parking garage
4 ❑ Repair, replacement or dormitory - Enter number
5 ❑ Wrecking (If multifamily residential, of units ------- - -i 22 ❑ Service station, repair garage
enter number of units in building in 15 ❑ Garage 23 ❑ Hospital, institutional
Part D, 13) 16 F-1 p
Carport 24❑ Office, bank, professional
6 r__1 Moving (relocation)
7 ❑ Foundation only 17 ❑ Other - Specify 25 ❑ Public utility
1 26 ❑ School, library, other educational
B. OWNERSHIP /!nrr�'r `-�' 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••,,••,,,,,,,,,. !p 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 .....................
n
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 ❑ Public or private company 48• Number of stories................
31 Wood frame 41 gPrivate (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 �1 Oil conditioning?
�J L. RESIDENTIAL BUILDINGS ONLY
37 Electricity 44 ❑ Yes 45 No 53. Number of bedrooms..............
38 ❑ Cool
39 ❑ Other - Specify Will there be an elevator? Full..........
54. Number of
46 n Yes 47 ❑ No bathrooms partial........
DEPT. OF BUILDING INSPECTIONS BUILDING '° • DO
! 212 Main Street O<
Northampton, MA 01060 PERMIT
36 - 186 VALIDATION
DATE April 17, 19 85 PERMIT NO. 188
APPLICANT Dennis Lenkowski ADDRESS 878 Burts Pit Rd. 01jMer
(N0.) (STREET) (CONTR'S LICENSE)
Addition NUMBER OF
PERMIT TO (_) STORY in QroundsWL�)1_ ing �l_DWELLING UNITS
(TYPE OF IMPROVEMENT) NO. (PROPOSED USE)
ZONING
AT (LOCATION)
878 Burtg Pit Rri- DIISTR CT SR
(NO.) (STREET)
BETWEEN AND
(CROSS STREET) (CROSS STREET)
LOT
SUBDIVISION LOT BLOCK SIZE
vPOOL
Y'4 IS TO BE 18 FT. WIDE BY 36 FT. LONG BY FT. IN HEIGHT AND SHALL CONFORM IN CONSTRUCTION
TO TYPE USE GROUP BASEMENT WALLS OR FOUNDATION
(TYPE)
REMARKS: permit for the construction and instaIlAtion of -- I'-n---''Ind Sibiu-Peel
AREA OR 648 sq. ft. ESTIMATED COST � 5 000.00 FEEMIT � 10.00
VOLUME
(CUBIC/SQUARE FEET)
Same as Applicant OWNER BU
ADDRESS ame as Applicant's BY
WHITE - FILE COPY . GREEN - FIELD COPY • CANARY - APPLICANT COPY • PINK - ASSESSORS COPY PJNf� I1P