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NOTES and Data (For department use)
4 in
4.
IV. IDENTIFICATION — To be completed by all applicants'
Name Mailing address Number, street, city, and State- ZIP code Tel. No.
O
Owner or
Lessee ( �j. / ��) �!
z/ i�GY� �d �tlf� (sVl130 '3O f(�{� k!i rt�l q d/OGQ-00?S LBcenser'No. Ot/J�fo7
Contractor
�O JD 7�
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 a plicati as his auth rized agent and we agree to conform to all applicable laws of this jurisdiction.
Signat r of plica t
Address Application date
/14 �cf �l►rP h�c ��l a.or�a 3 d 3-8's
DO NOT WRITE ;BELOW THIS LINE
V. LAN REVIEW RECORD — For office use
Plans Review Required Check Plan Review Date (Plans B Date Plans
Fee $tar}ed Y Approved BY Notes
BUILDING $
PLUMBING $
MECHANICAL $
ELECTRICAL $
OTHER $
VI. ADDITIONAL PERMITS REQUIRED OR OTHER JURISDICTION APPROVALS
L=
Permit or A royal Check Date Date
pP 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
II. VALIDATION
Building
Permit number FOR DEPARTMENT USE ONLY
/�
Building.
Permit issued �� 6�G!•�1 lq use Group
Building Fire Grading
Permit Fee v
Live Loading
Certificate of Occupancy $ occupancy Load
Drain Tile $ Approve
Plan Review Fee
TITLE
i
CITY OF NORTHAMPTON
g. MASSACHUSETTS
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: I, 11, 111, IV, and IX. 0
_ • yj" ZONING
I• AT (LOCATION) ��� DISTRICT '
LOCATION (NO.) (STREET)
OF BETWEEN AND
BUILDING (CROSS STREET) (CROSS STREET)
LOT
SUBDIVISION LOT BLOCK SIZE
to
II. TYPE AND COST OF BUILDING - All applicants complete Parts A - D
M
A. TYPE OF IMPROVEMENT D. PROPOSED USE — For"Wrecking" most recent use m
—1
1 ❑ New building Residential Nonresidential
2 [g Addition(l/ residential, enter number 12 One family 18 ❑ Amusement, recreational
of new housing units added, if any, 13 ❑ Two or more family — Enter 19 ❑ Church, other religious
in.Part D, 13) number of units— — — — --)� 20❑ Industrial
3 Alteration (See 2 above) 14 ❑ Transient hotel, motel,
21 ❑ Parking garage
4 Repair, replacement or dormitory — Enter number
5 ❑ Wrecking (1l 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) p ` ❑
9 ) c��� _ 25 Public utility
17 ether — SpeciJy
7 ❑ Foundation only 26 ❑ School, library, other educational
s
B. OWNER IP �yT / �C,t/ T.IJ l�✓( ��2 27 ❑ Stores, mercantile
28 ❑ Tanks, towers
8 Private (individual, corporation, `
nonprofit institution, etc.) /t/ ` 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................ �l ��0 UC' 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..................... .2(-'Jcy
b. Plumbing ..................... Oc7
c. Heating, air conditioning.........
d. Other (elevator, etc.)............
11. TOTAL COST OF IMPROVEMENT Is /J C)00OO
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❑MAKonry (wall bearing) 40 Public or private company ai/X�3
49. Total square feet of floor area,
31 Wwood frame 41 ❑ Private (septic tank, etc.) all floors, based on exterior
32 ❑ Structural steel dimensions ..................... 1p7 7 Q,
33 ❑ Reinforced concrete H. TYPE OF WATER SUPPLY
34 ❑ Other — SpeciJy
42 ublic or private company 50. Total land area, sq. ft. ...........
43 ❑ Private (well, cistern) K. NUMBER OF OFF-STREET
PARKING SPACES X
51. Enclosed .......................
F. PRINCIPAL TYPE OF HEATING FUEL I. TYPE OF MECHANICAL
35 Gas Will there be central air 52. Outdoors........................
36 ❑ conditioning? C
L. RESIDENTIAL BUILDINGS ONLY
37 C Electricity 44 ❑ Yes 45 i,` No 53. Number of bedrooms..............
38 ❑ Coal
39 ❑ Other — Specify Will there be an elevator? Full.........
54. Number of
46 ❑ Yes 47 No bathrooms
Partial.......
DEPT. OF BUILDING INSPECTIONS BUILDING ° t �✓
t 212 Main Street O<
Northampton, MA 01060 PERMIT as
17D - 6 VALIDATIONn
DATE Ma 23 �85 Pyp�7{�-MIT NO. 281 008 764
APPLICANT Walter Dziubek & On Ul 0RESS 1!.,8.--Box 1? r lorence
(NO.I (STREET) (CONTR'S LICENSE)
PERMIT TO Addition/Alteration (_) STORY One Family NUMBLER OF DWELING UNITS
(TYPE OF IMPROVEMENT) NO. (PROPOSED USE)
AT (LOCATION)
558 Bridge Road ZONING
(NO.) (STREET)
BETWEEN AND
(CROSS STREET) (CROSS STREET)
LOT
SUBDIVISION LOT BLOCK SIZE
ADDITION
)qi�IS TO BE 24 FT, WIDE BY 53
FT. LONG BY FT. IN HEIGHT AND SHALL CONFORM IN CONSTRUCTION
TO TYPE USE GROUP BASEMENT WALLS OR FOUNDATION
(TYPE)
REMARKS: ermit to change roof pitch and add second story (bedroom and un-
ed room an 2 bath)
AREA OR 1272 SCI• f t• ESTIMATED COST 181000.00 FEE
$ 56.00
VOLUME
(CUBIC/SQUARE FEET)
William Kaiser
OWNER 558 brtcltge Road, BUIL
ADDRESS BY
WHITE - FILE COPY . GREEN - FIELD COPY • CANARY - APPLICANT COPY • PINK - ASSESSORS COPY pjNT p
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