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O ZONING I• AT (LOCATION) t/'- ..+ —� ` � \ 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 completes Parts A — D A. TYPE OF IMPROVEMENT D. PROPOSED USE For"Wrecking" most recent use M M 1 ❑ New building Re idential Nonresidential 2 Addition(1 residential, enter number ❑ 12 One Family 18 ❑ Amusement, recreational of new bousing units added, if any, Church, other religious 13 Two or morelfamily — Enter 19 in Part D, 13) number of r nits— — — — > 20 ❑ Industrial 3 Alteration (See 2 above) 14 Transient hotel, motel, ❑ 21 L—� Parking garage 4 L 2epair, replacement or dormitoryl, — Enter number 5 ❑ Wrecking (11 multifamily residential, of Units —------ — --}a 22 L] Service station, repair garage enter number of units in building in 15 ❑ Garage 23 Hospital, institutional Part D, 13) ❑ 6 Moving (relocation) 16 rport 24 L_.� Office, bank, professional 7 Foundation only 17 ❑ Other — SpcPci/y 25 Public utility 26 ❑ School, library, other educational B. OWNER IP 1 16 t 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 `( proc thing plant, machine shop, laundry building at hospital, elementary prates 10. Cost of improvement•,,,,,,,,,,•,,•, F i 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....................... I1 I 1 b. Plumbing ....................... I c. Heating, air conditioning.......... y�tt d. Other (elevator, etc.)............ ✓\ 11. TOTAL COST OF IMPROVEMENT Is E2Lc *{� III. SELECTED CHARACTERISTICS OF BUILDING — For new'Ibuildings and additions, complete Parts E — L; for wrecl ing, complete only Part J, for all others skip to IV. E. PRINCIPAL TYPE OF FRAME G. TYPE OF SEWAGE DISPOSAL J. DIMENSIONS 30 ❑ sonr wall bearing) 40 ❑ Public or p )company 48• Number of stories................ Y ( 9) private �' 49. Total square feet of floor area, 31 Wood frame 41 �� Private (septic tank, etc.) all floors, based on exterior 32 Structural steel dimensions ..................... 33 Reinforced concrete H. TYPE OF WATER SUPPLY 34 n Other — Specify 42 Public or private kompany 50. Total land area, 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 ....................... 35 E Gas Will there be central air 52. Outdoors........................ 36 Oil conditioning? 37 j Electricity 44 I_ Yes 45 ir'❑' No L. RESIDENTIAL BUILDINGS ONLY _ —. 53. Number of bedrooms.............. 38 L_] Coal 39 L 1 Other — Specify Will there be an elevator{ Full.......... 54. Number of 46 [--1 Yes 47 � No bathrooms partial........ IV. IDENTIFICATION — To be completed by all applicants Name Mailing address — Number, stmt, city, and State ZIP code Tel. No. Owner or Lessee h 1 _ Builder's 2. I' 't 1 '�L �'L — License o. 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. Signatur9tofa plicant ,- Address 3 �K'i ( `LO2't C pJi, on date r 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 q Fee Started y Approved y BUILDING $ PLUMBING $ MECHANICAL $ ELECTRICAL $ OTHER $ V1. ADDITIONAL PERMITS REQUIRED OR OTHER JURISDICTION APPROVALS Date Date Permit or Approval Check Obttai ed 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 FOR DEPARTMENT USE ONLY Permit number Building �n Use Group Permit issued 1 Y \�� 19 2E) Bui(ding /��l_- Fire Grading Permit Fee $ �� t��' 1 Live Loading Certificate of Occupancy $ Occupancy Load Ajaproved by: Drain Tile Cl J s Plan Review Fee TITLE I d "° j Aka City of Northampton REQUIRED INSPECTIONS 1 . Footings and Walls � f BUILDING DEPARTMENT 2 . Structural Components in Place 3 . Complete Building No. 118 Office of the Building Inspector Date March 15, 1990 BUI DING P RMIT THIS MAY CERTIFY THAT Marjery Sly Insp. on Site — Foundations has permission to replace existing deck Insp. of Plumbing — Rough situated on 23 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 r, months from date. Building Insp. — Finish Note: A certificate of occupancy will be issued by this office upon Y 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 O THE PREMISES Certificate of Occupancy Building Inspector X14^•