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PROPOSED USE — For"Wrecking" most recent use m M 1 ❑ New building Residential Nonresidential 2 ❑ Addition(If residential, enter number 12,KOne family 18 F-1 Amusement, recreational of new housing units added, if any, 13 ❑ Two or more family — Enter 19 ❑� Church, other religious i Part D, 13) number of units— — — — - 3 Al teration (See 2 above) -)� 20❑ Industrial 14 ❑ Transient hotel, motel, 21 Parking garage 4 Repair, replacement or dormitory — Enter number 5 ❑ Wrecking (If 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 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 processing plant, machine shop, laundry building at hospital, elementary 10. Cost of improvement•,•,,.•,,....... 0 e) 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..................... SO& �LLGZ ^^f7 ,�go���z'rJyt b. Plumbing ..................... 000 f CAAt-� `-22 U c. Heating, air conditioning.......... o 0 d. Other (elevator, etc.)............. 11. TOTAL COST OF IMPROVEMENT $ III. SELECTED CHARACTERISTICS OF WILDING — 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, all floors, based on exterior 32 ❑ Structural steel dimensions ..................... 33 ❑ Reinforced concrete H. TYPE OF WATER SUPPLY 34 ❑ Other — Specify 42 Public or private company 50. Total land area, sq. ft. ........... LJ 43 ❑ Private (well, cistern) K. NUMBER OF OFF-STREET PARKING SPACES 51. Enclosed ....................... 7 F. PRINCIPAL TYPE OF HEATING FUEL 1. TYPE OF MECHANICAL 35 ❑ Gas Will there be central air 52. Outdoors........................ 36;>< Oil conditioning? L. RESIDENTIAL BUILDINGS ONLY ^� 37 ❑1 Electricity 44 ❑ Yes 45 K, No 53. Number of bedrooms.............. 3 38 ❑ Coal 39 ❑ Other — Specify Will there be an elevator? Full.......... _ _ 54. Number of 46 1 Yes 47 i� No bathrooms I Partial....... IV. IDENTIFICATION — To be completed by all applicants Name Mailing address — Number, street, city, and State ZIP code Tel. No. O o/ � 3v7 A"' "'i /e� ©�f-3 Owner or Lessee 2. YT.�/6)W1AT 1 L �l� i c i n e N Ifr G^ /�-/ 7 / 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 LJ 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 ate Permit or Approval Check Obta ned 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 �1 _ FOR DEPARTMENT USE ONLY Permit number �J Building mA Use Group Permit issued '� l� �_ 19 _ Fire Grading Building Permit Fee $ G. O c Live Loading Certificate of Occupancy $ Occupancy Load Approved by: Drain Tile $ ' Plan Review Fee $ TITLE DEPT. OF BUILDING INSPECTIONS BUILDING Zo t212'MAin Street 04 Northampton, MA 01060 PERMIT 5 - 52 VALIDATION DATE Feb. 24, 1g 88 Hill NO. 76 APPLICANT John ieminski . Inc. _ ADDRESS 387 Rocky Hi l l Road On File (NO.) (STREET) (CONTR'S LICENSEI Alteration One Family NUMBER OF PERMIT TO (_1 STORY DWELLING UNITS (TYPE OF IMPROVEMENT) NO. (PROPOSED USE) A01.115on KoacF 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) permit for interior alterations to eixsting single family dwelling/also to add REMARKSf ec AREA OR 23,500-00 PERMIT 60.00 VOLUME ESTIMATE[) COST .� FEE $ (CUBIC/SQUARE FEET) OWNER John Herlihy U UILDIN ADDRES U On Oa P WHITE - FILE COPY . GREEN - FIELD COPY • CANARY - APPLICANT COPY ■ PINK - ASSESSORS COPY p"'. P