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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 dote 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 Start 1d Approved BUILDING $ PLUMBING $ MECHANICAL $ ELECTRICAL $ OTHER $ VI. ADDITIONAL PERMITS REQUIRED OR OTHER JURISDICTION APPROVALS Date Date Permit or Approval Check Obtained Number By Permit or Approval Chec 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 FOR DEPARTMENT USE ONLY Permit number Building Use Group Permit issued 19I Building C Fire Grading Permit Fee $ r/sJ Live Loading Certificate of Occupancy $ occupancy Load $ Approved by: Drain Tile Plan Review Fee $ TITLE f r CITY OF NORTHAMPTON �. MASSACHUSETTS • a $ OFFICE of the INSPECTOR of BUILDINGS Page 17 C. Plot "" APPLICATION FOR INSPECTOR ZONING PERMIT AND BUILDING PERMIT z IMPORTANT — Applicant to complete all items in sections: 1, 11, 111, IV, and IX. O / ZONING 1/A,L I• AT (LOCATION) z ,��/!� �� DISTRICT- LOCATION (NO.) (STREET) OF BETWEEN 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 Im M 1 ❑ 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) 13 Two or more family – Enter 19 � Church, other religious 3 Alteration (See 2 above) number of units– – – – __)0-- 20 ❑ Industrial ❑ 14 ❑ Transient hotel, motel, 21 C� 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) 7 ❑ Foundation only 17 ❑ Other – Speci/y 25 ❑ Public utility \ 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,,,,,,,,,,,•,,,, ©t} v"" 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 I$ �^d 'Ca III. SELECTED CHARACTERISTICS OF BUILDING — For new buildings and additions, complete Parts E — L; for wrecking, complete only Part J, for oil 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 410 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 50. Total land area, sq. ft. .......... 34❑ Other – Specify 42 [7 Public or private company 43 L 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 ❑ 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 elevators Full.......... 54. Nurn ber of 46 ( -1 Yes 47 '—, 1 No bathrooms Parti a I......J v DEPT. OF BUILDING INSPECTIONS BUILDING Z 212 Main Street '< < Northampton, MA 01060 PERMIT 17C - 282 VALIDATION DATE January 12, 19 88 PERMIT NO. 31 APPLICANT Carol Ryder ADDRESS 18 Lilly St. , Florence Owner (NO.) (STREET) (CONTR'S LICENSE) NUMBER OF PERMIT TO Re Ii r/Reel acement. (_) STORY New Chimney DWELLING UNITS (TYPE OF I PROVEMENT) N0. C (PROPOSED USE) AT (LOCATION) 18 Lilly St. . Florence DIOSTR CT URB (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: _�erMi t fnr the i nct a 1 1 At i nn of a new rh i mney Cille t.n fire damaoQ AREA OR 500.00 PERMIT 10.00 VOLUME ESTIMATED COST $ FEE (CUBIC/SQUARE FEET) OWNER Same as Applicant ADORES S ame a$ pp lcan T S BUIQ �. �• WHITE - FILE COPY . GREEN - FIELD COPY • CANARY - APPLICANT COPY ■ PINK -(ASSESSORS COPY PINE P