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IDENTIFICATION — To be completed by all applicants Name Mailing address — \'umber, street, city, and State ZIP code Tel. No. i. SQ ' �( 'Ir fi h . �a ©1664 6?4—?0 Owner or Lessee y� / 2. }� 3l{i� e� 171,C, PQ p� c 7 A. 0 0 �� Builder's 733-7603 License No. Contractor tl3 3. Architect or Engineer I hereby certify that the prop sed work is authorized by the owner of record and that I have been authorized by the owner to make this applicatio s hi authorized agent and we agree to conform to all applicable laws of this jurisdiction. Signature f plicant Address Application date DO NOT WRITE BELOW T HK LINE V. PLAN REVIEW RECORD — For office use Plans Review Re wired Check Plan Review Date Plans By Date Plans By Notes 9 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 Building / Use Group Permit issued ' ! ' 1- 19 Building Fire Grading Permit Fee $ S�r nx) Live Loading Certificate of Occupancy $ Occupancy Load Approved by: Drain Tile $ Plan Review Fee $ TITLE CITY OF NORTHAMPTON MASSACHUSETTS $ e OFFICE of the INSPECTOR of BUILDINGS T Page z Plot APPLICATION FOR INSPECTOR ZONING PERMIT AND BUILDING PERMIT IMPORTANT — Applicant to complete all items in sections: 1, I1, 111, IV, and IX. / O ZONING I •AT (LOCATION) C7 h////C, e I 1. - DISTR CTI/ l / LOCATION IN 0.) (STREET) OF BETWEEN 1;5 r 6e�4_ le (e A I AND /\� to 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 F__1 New building Residential Nonresidential 2[1?00'Addition(If residential, enter number 12 One family 18 0 Amusement, recreational of new housing units added, if any, in Part D, 13) 13 Two or more family — Enter 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 — Enter number 5 Wrecking (If multi family residential, of units ——————— — -i 22 Service station, repair garage enter number of units in building in 15 C Garage 23 n Hospital, institutional Part D, 13) ❑ 6 ED Moving (relocation) 16 Carport (� 24 Office, bank, professional 7 D Foundation only 17 � Other — Specify Soon 2C1C` n 25 Public utility 26 School, library, other educational B. OWNERSHIP 27 Stores, mercantile 8 Private (individual, corporation, 28 Tanks, towers nonprofit institution,etc.) 29 0 Other — Specify 9 D 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,,.••,,,........ 41)� 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 I$ f/ :5 fy 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 [__1 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 ..................... 3 p`C 33 Reinforced concrete H. TYPE OF WATER SUPPLY 50. Total land area, sq. ft. ........... 34 Other — Specify 42 0 Public or private company 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 _es 1V/' No 53 N b j -- . umber of bedrooms.............. 38 Coal 39 Other — .Specify Will there be an elevotor'l Full.......... 54. Number of r 46l � Yes 47I bothrooms No Partial........ DEPT. OF BUILDING INSPECTIONS BUILDING + 212 Main Street oa Northampton, MA 01060 PERMIT 17A - 307 VALIDATION lit 646 DATE September X A, 19 87 PERMIT NO. APPLICANT & W Builders' Inc _ ADDRESS Pomeroy SXX Rd. , Montgomery 016120 (NO.) (STREET) (CONTR'S LICENSE) NUMBER OF PERMIT TO Add i t i nn (_) STORY SI)nroom DWELLING UNITS (TYPE OF IMPROVEMENT) NO. (PROPOSED USE) ZONING URA AT (LOCATION) 67 Hi 11 crPSt Drive DISTRICT (NO.) (STREET) 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: AREA OR 323 sq. ft. ESTIMATED COST $ 14,650.00 FEE s 56.00 VOLUME (CUBIC/SQUARE FEET) OWNER David Jorczak BUILD' PT. �•� _�//� • ADDRESS 1 cres rive BY .zi:a 41 WHITE - FILE COPY . GREEN - FIELD COPY • CANARY - APPLICANT COPY • PINK ^ ASSESSORS COPY po..fp