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NOTES and Data — (For department use)
IV. IDENTIFICATION — To be completed by all applicants
rAAp+Nam�e/ ,7 ( Mailing address – Number, street, city, and State ZIP code Tel. No.
1.
Owner or (t� / V /I vG�(pG+ (r/YLG'�J ( 7
Lessee
2. Jc �11t1(fici So s-,— f�/y�t4lJO a /Z1/fdT Licenser'No.
Contractor
03q�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 pplicant Address Application date
y \
7 fed'
00 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 Approva I Check Date Number By Permit or Approval Check Date Number B
Obtained Obtained 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 C Use Group
Permit issued KA 19
Building Fire Grading
Permit Fee $
Live Loading
Certificate of Occupancy $ c panty Load
Approve
Drain Tile $
Plan Review Fee $
TITLE
CITY OF NORTHAMPTON
MASSACHUSETTS
$ e OFFICE of t e INSPECTOR of BUILDINGS
Page Plot APPLICATION FOR
INSPECTOR ZONING PERMIT AND
BUILDING PERMIT
z
IMPORTANT — Applicant to complete all items in sections: f1, 11, 111, IV, and IX. 0
I• AT (LOCATION) ? ) V. 1il ZONING ' r�
,.r DISTRICT
LOCATION (NO.) (STREET)
OF BETWEEN KwV,Gn�✓� ,t'e�, GAS -AND-
BUILDING (CROSS STREET) (CROSS STREET)
LOT
SUBDIVISION LOT BLOCK SIZE
N
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 D New building Residenti I Nonresidential
2 �Addition(If residential, enter number 12 ' ne family 18 Amusement, recreational
of new housing units added, if any,
in Part D, 13) 13 Two or more fomily - Enter 19 L ] Church, other religious
number of units- - - - -> 20 �] Industrial
3 L� Alteration (See 2 above)
14 Transient hotel, motel,
Repair, replacement "-- 21 r-] Parking garage
4 Re
p p or dormitory - Enter number
5 ❑ Wrecking (If multifamily 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 u Moving (relocation) --)
17 � � Other - Specify— 25 Public utility
Y
7 Foundation only
26 School, library, other educational
B. OWNERSHIP 27 Stores, mercantile
8 Private (individual, corporation, 28 ` Tanks, towers
nonprofit institution, etc.) 29 L_- Other - S p ecr fr'9 L-] 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,,,,,,,,,,,,,,,, g(j (;CC)4 IlLshool, 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 i j,being changed, enter proposed use.
in the above cost
a. Electrical.......................
e2d&z UAA JhP4V,&_)2!A__ CATA
b. Plumbing ....................... ;zsu C1
c. Heating, air conditioning.......... C), tJ
d. Other (elevator, etc.).............
11. TOTAL COST OF IMPROVEMENT ,?-/ 7�
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 L._J Masonry (wall bearing) 40 E_] Public or com p an y 48, Number of stories................
31 �ood frame 41 vote (septic tank, etc.) 49. Total square feet of floor area, d•
all floors, based on exterior ��y
32 C Structural steel dimensions ..................... 4S//�,.i
33 Reinforced concrete H. TYPE OF WATER SUPPLY
_ 50. Total land area, sq. ft. ,,.........
42 —j Pu34 Other - S eci ti blic or P rivate company
43 L Private (well, cistern) K. NUMBER OF OFF-STREET
PARKING SPACES
51. Enclosed ....................... 0
F. PRINCIPAL TYPE OF FEAT G FUFk I. PeX MECHANICAL
35 Gas es . *A,Will fMer4, central air 52. Outdoors........................ 0
36 _] oil i _,cohd L. RESIDENTIAL BUILDINGS ONLY
37 Cectricity °. 44 '( ] Yes 45 �X No 53. Number of bedrooms..............
38 Coal
39 Other - .Speedy Will there be an elevator° Full...f.
54. Number of
46 Yes 47l No bathrooms
'-`C Partial.......
�� .�,Q �
u
DEPT. OF BUILDING INSPECTIONS BUILDING Z° Do
! 212 Main Street O<
IL
Northampton, MA 01060 PERMIT .9
Olf 4 - 4 VALIDATION
DATE 0--South.;Wiffia'TS U a52
APPLICANT John Punska ADDRESS
(NO.) (STREET) (CONTR'S LICENSE)
Addition One Family NUMBER OF
PERMIT TO (_) STORY DWELLING UNITS
(TYPE OF IMPROVEMENT) NO. (PROPOSED USE)
520 Audubon Road, Leeds ZONING RR
AT (LOCATION) 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, permit for the addition of a bedroom over existing attached garage
AREA OR VOLUME 528 $Q• ft• ESTIMATED COST $ 21 ,/5 FE ) 80-00
(CUBIC/SQUARE FEET)
OWNER Grea Kelleher e I�lF
ADDRESS 520 Audubon Rd. , Leeds
WHITE - FILE COPY . GREEN - FIELD COPY • CANARY - APPLICANT COPY • PINK ^ ASSESSORS COPY p 0.1p