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PROPOSED USE — For"Wrecking" most recent use m m -a 1 ❑ New building Re i ential Nonresidential 2�Addition(If residential, enter number 12 One family 18 ❑ Amusement, recreational of new bousing units added, if any, in Part D, 13) 13 N Two or more family - Enter 19 ❑ Church, other religious number of units- - - - -o. 20 ❑ Industrial 3 ❑ Alteration (See 2 above) 14 ❑ Transient hotel, motel, 21 Parking garage 4 ❑ Repair, replacement or dormitory - Enter number 5 ❑ Wrecking (11 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 Carport 24 ❑ Office, bank, professional 6 ❑ Moving (relocation) 17 ❑ Other - Specify 25 ❑ Public utility 7 ❑ Foundation only 26 ❑ School, library, other educational B. OWNERSHIP 27 ❑ Stores, mercantile 8 IXI Private (individual, corporation, 28 ❑ Tanks, towers Y � nonprofit institution, etc.) 29 C7 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,,,,,,,,•,,,,,,, Q C, D 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....................... S v� b. Plumbing .................... c. Heating, air conditioning......... 5 DD d. Other (elevator, etc.)............. 11. TOTAL COST OF IMPROVEMENT Is �� 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�JEl.00d frame 41 .Private (septic tank, etc.) 49• Total square feet of floor area all floors, based on exterior 1/ 32 ❑ Structural steel dimensions .................... lG o 33 ❑ Reinforced concrete H. TYPE OF WATER SUPPLY 34 ❑ Other - Specify 42 Public or private company 50. Total land ores, 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 ....................... 'L 35 ❑ Gas Will there be central air 52. Outdoors........................ 36> Oil conditioning? L. RESIDENTIAL BUILDINGS ONLY 37 FJ Electricity 44 ❑ Yes 45 No 53. Number of bedrooms.............. 3 38 ❑ Cool a 39 ❑ Other - Specify Will there be an elevator? Full.......... 54. Number of 46 n Yes 47/f—:f No bathrooms partial........ IV. IDENTIFICATION — To be completed by all applicants i Name Mailing address — Number, street, city, and Stag ZIP code Tel. No. 1. V I l IS Pt r ,9 W Owner or Lessee LL.�$S f`7 /h5S & 2 QQ Builder's J 2. L I L �^S`JIL� /`—CC t (L K o 9d License No. S�w 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 appli n Address Application date L2-F DO 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 q Fee Started y Approved y BUILDING $ PLUMBING $ MECHANICAL $ ELECTRICAL $ OTHER Is VI. ADDITIONAL PERMITS REQUIRED OR OTHER JURISDICTION APPROVALS Date Permit or Approval Check Obta ned Number By Permit or Approval Check Obttaitned 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 -�(T FOR DEPARTMENT USE ONLY Permit number Building 1 Use Group Permit issued d2 19 Building / �`� Fire Grading Permit Fee $ (/ U Live Loading Certificate of Occupancy $ Occupancy Load Approved by:. Drain Tile $ Plan Review Fee $ TITLE a DEPT. OF'PUILDING INSPECTIONS BUILDING ~ i� + ! , 232-Main Street Northampton, MA 01060 PERMIT <IL 5 - 52 VALIDATION DATE D4NYMMINX Dec. 1 , 19 87 PERMIT NO. 792 APPLICANT John ieminSki - TnC_ ADDRESS 387 Rocky Hill Road 017889 (NO.) (STREET) (CONTR'S LICENSE) �,�,� NUMBER OF PERMIT TO Arid i i i na (_1 STORY nl'1P Fami 1 v DWELLING UNITS (TYPE OF IMPROVEMENT) NO. (PROPOSED USE) ZONING RR AT (LOCATION) 107 AudOhon Road 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 IrrrEl REMARKS: AREA OR ESTIMATED COST 10 000 00 PER 160 $ $ 36.00 VOLUME q. f t. (CUBIC/SQUARE FEET) OWNER LI John Herlihy BUILDING PT. ADORESS U on Road BY WHITE - FILE COPY . GREEN - FIELD COPY ■CANARY - APPLICANT COPY • PINK - ASSESSORS OPY 0--fP nommmomw