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NOTES and Data — (For department use)
(f
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IV. IDENTIFICATION — To be completed by all applicants
Name Mailing address — Number, street, city, and State ZIP code code Tel.. No.
1.Owner or //.Iy //� / /7 �t J 7 X`�G� 06,0 ��/`-7
Lessee .._D E&',Sl. /��/ -' L- %K.���.'�_�_ /ter) / 9 7
Builder's
2 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
Permit or Approval Check Date Number B Permit or Approval Check Dare Number B
PP ec Obtained y PP Obtained um y
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 ! I I
Building. Use Group
Permit issued 19
Fire Grading
Building /'� /�T
Permit Fee $ -/ L/( / Live Loading
Certificate of Occupancy $
A rove by:
Drain Tile $
Plan Review Fee $
TITLE
CITY OF NORTHAMPTON
MASSACHUSETTS
$ e OFFICE of the INSPECTOR of BUILDINGS
Page R Plot 7�
g APPLICATION FOR
INSPECTOR ZONING PERMIT AND
BUILDING PERMIT
IMPORTANT — Applicant to complete all items in sections: 1, 11, 111, IV, and IX. O
I• AT (LOCATION) �l P` IA)(L l% f"'GI� �C/L'��f zI2
ZONING IT'Ile
LOCATION (NO.) REET) /
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 -N+
A. TYPE OF IMPROVEMENT D. PROPOSED USE — For"Wrecking" most recent use M
M
1 D 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) .7)eC[/ 13 ❑ Two or more family - Enter 19 ❑ Church, other religious
` number of units- - - - -.� 20 Industrial
3 ❑ Alteration (See 2 above) 14 ❑ Transient hotel, motel, ❑
4 ❑ Repair, replacement 21 ❑ Parking garage
or dormitory — Enter number
5 ❑ Wrecking (11 multifamily residential, of units ------- - -- 22 ❑ Service station, repair garage
enter number of units in building in 15 ❑ Garage 23 ❑ Hospital, institutionol
Past D, 13)
6 F-1 Moving (relocation)
16 ❑ Carport 24❑ Office, bank, professional
17 Other - Specify k 25 ❑ Public utility
7 ❑ Foundation only
/ / / 26 ❑ School, library, other educational
B. OWNERSHIP l�) X�(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
0C' processing plant, machine shop, laundry building at 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.).............
11. TOTAL COST OF IMPROVEMENT 1$
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, ry
32 Structural steel
all floors, based on exterior Li
dimensions ..................... 160 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 n Oil conditioning?
7 L. RESIDENTIAL BUILDINGS ONLY
37 ❑� Electricity 44 [--] Yes 45 No 53. Number of bedrooms.............
38 ❑ Coo I
39 Other - Specify Will !here be an elevator? Full..........
54. Number of
46 [-_]1 Yes 47 ❑ No bathrooms
Partial.......
Department of Building Inspections
212 Main Street --
N
(V
orthampton, Mass. 01060 BUILDING 1' n-
23A '11 /� ,
PERMIT a
- 176 VALIDATION
DATE May 11, 19 84 PERMIT NO. 191
APPLICANT
Denise Kain ADDRESS 118 Pine St. , Florence Owner
(NO.) (STREET) (CONTR'S LICENSE)
Addition 19KHRR Deck NUMBER OF
- PERMIT TO (_) STORY DWELLING UNITS _
(TYPE OF IMPROVEMENT) NO. (PROPOSED USE)
AT (LOCATION)
28 Pine Street Florence ZONING CT URB
DISTR
(NO.) (STREET)
BETWEEN AND
(CROSS STREET) (CROSS STREET)
LOT
SUBDIVISION LOT BLOCK SIZE
Deck
XBY&bX,r��i IS TO BE 10 FT. WIDE BY 16 FT. LONG BY FT. IN HEIGHT AND SHALL CONFORM IN CONSTRUCTION
TO TYPE USE GROUP BASEMENT WALLS OR FOUNDATION
(TYPE)
REMARKS: permit to construct a deck onto the rear of existing house
VOLUME 160 sq. ft. ESTIMATED COST $ 500'00 FEEMIT 10.00
(CUBIC/SQUARE FEET)
OWNER
Denise Kain ✓ F
ADDRESS 28 Pine St. , Florence, Mass. 01060 BYIL �
WHITE - FILE COPY . GREEN - FIELD COPY ■ CANARY - APPLICANT COPY - PINK - XSSESSORS COPY