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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.
Owner or
a A 1 La ILQ S'T
Lessee
Lk Q So Builder's
1• License No. (j
Contractor
AWS
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
9 10g ) Y�
00 NOT WRITE BELOW THIS LINE
V. PLAN REVIEW RECORD — For office use
Plans Review Required Check Plan Review Date Plans B Date Plans B Notes
Fee Started y Approved y
BUILDING $
PLUMBING $
MECHANICAL $
ELECTRICAL $
OTHER $
VI. ADDITIONAL PERMITS REQUIRED OR OTHER JURISDICTION APPROVALS
Permit or Approval Check Date Number B Permit or Approval Check Date Number B
Obtained y pp 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 Use Group
Permit issued 19
Building Fire Grading
Permit Fee $ ( V
Live Loading
Certificate of Occupancy $ Occupancy Load
Approved by:
Drain Tile $ � r
��' ��% �G�t;--'"° u-°'Z•_._._..,—moo'
Plan Review Fee "[
TITLE
CITY OF NORTHAMPTON
MASSACHUSETTS
$ e OFFICE of the INSPECTOR of BUILDINGS
Page Plot — APPLICATION FOR
ZONING PERMIT AND
INSPECTOR BUILDING PERMIT
z
IMPORTANT — Applicant to complete all items in sections: 1, 11, 111, IV, and IX. C)
ZONING
cs� DISTRICT�r�rp�l
I• AT (LOCATION) T 1 � 6
LOCATION IN 0.) (STREET) Q J �]�f '�7
OF BETWEEN rl C d �� AND )R j,C' C11�C_C 5
BUILDING (CROSS STREET) (CROSS STREET)
LOT
SUBDIVISION LOT BLOCK SIZE
II. TYPE AND COST OF BUILDING — All applicants complete Parts A — D A
A. TYPE OF IMPROVEMENT D. PROPOSED USE - For"Wrecking" most recent use m
M
1 F-1 New building Residential Nonresidential
2 [�] Addition(If residential, enter number 12 One family 18 Amusement, recreational
of new housing units added, if any,
. Part D, 13) 13 Two or more family — Enter 19 Church, other religious
number of units— — — — --� 20 Industrial
3 Alteration (See 2 above)
14 Transient motel,,
— 21 Parking garage
4 Repair, replacement
or dormitory F'nter number
5 Wrecking (If multifamily residential, of units ——————— — -- 22 L, Service station, repair garage
enter number of units in building in 15 Garage 23 Hospital, institutional
Part D, 13) l 16 C Carport
24 �� Office, bank, professional
J
6 Moving (relocation) 17 � Other — Specify 25 Public utility
7 Foundation only 26 School, library, other educational
B. O7riyote HIP 27 Stores, mercantile
28 Tanks, towers
8 (individual, corporation,
nonprofit institution, etc.) 29 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,,,,,.•,,,...... 0� school, secondary school, college, parochial school, parking garage for
deportment 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 �^ i'
a. Electrical....................... �C �4 0 r -T Nrf
b. Plumbing .......................
01ti
c. Heating, air conditioning..........
d. Other (elevator, etc.)............. �M
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
48. Number of stories................
30 ❑ Ma onry (wall bearing) 40 -�j Public or private company
31 Wood frame 41 p 49. Total square feet of floor area,
Private (septic tank, etc.) all Floors, based on exterior
32 Structural steel dimensions .....................
33 Reinforced concrete H. TYPE OF WATER SUPPLY
50. Total land area, sq. ft. ..........
34 Other — Specify 42 n Public or private company
43 L� Private (well, cistern) K. NUMBER OF OFF-STREET
PARKING SPACES
51. Enclosed .......................
F. PRINCIPAL TYPE OF HEATING FUEL I. TYPE OF MECHANICAL
3S ❑ Gas Will there be central air 52. Outdoors........................
36 n 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 elevatory 54. Number of Full..........
-
46 Yes 47 Lj No bathrooms
Partial.......
�0°e City of Northampton REQUIRED INSPECTIONS
$ 1 . Footings and Walls
BUILDING DEPARTMENT 2 Placetural Components in
3. Complete Building
No. 71S Office of the Building Inspector
Date October 4, 19 89
BUI DING P RMIT
THIS MAY CERTIFY THAT John Punska Insp. on Site — Foundations
has permission to convert existing carport into a garage Insp. of Plumbing — Rough
situated on 118 Lake St. , Florence Insp. of Plumbing — Finish
provided that the person accepting this permit shall in every re- Insp. of Wiring — Rough
spect conform to the terms of the application on file in this office,
and to the provisions of the Statutes and the Ordinances relating Insp. of Wiring — Finish
to the Construction, Maintenance and Inspection of Buildings in Insp. of Health (Septic Tanks)
the City of Northampton. Any violation of any of the terms above
noted is an immediate revocation of this permit. Expires six Building Insp. — Rough
months from date.
Building Insp. — Finish
Note: A certificate of occupancy will be issued by this office upon
return of this card signed by the Plumbing, Wiring and Building Smoke Detectors (Fire Dept.)
Inspectors. Gas Inspection
THIS CARD MUST BE DISPLAYED IN A CONSPICUOUS PLACE ON THE PREMISES
Certificate of Occupancy
' uil ing`Inspect r
PAKMASK P