06-029 (3) 6 DEPT. FILE COPY
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BUILDING .1
� PERMIT VALIDATION
TE / A� ,�� 19A. PER IT . •. 9ti
i _y l 7.A' J
APPLICANT .!_�A' .r(�y00 J AADOR£9��� „... e�
(MO.) 3TRE£T{ NUMBER OF• iCOXIR's LICENSE}
PERMIT TO ! lleeee \ /Y_ ^" _ (o I STORY DWELL IING UNITS __
(TYPE OF IMPROYEMEKTI (PROPO$tO FEE/ �/
/��'j//j ZONING e .
AT (LOCATION) tir�i/ e ,./_.XtY✓" _DISYRICT
(RO.1 MATED
ah BETWEEN__ ANO
S I CROS! sTBEETI (CROSS sTAEETI
O LOT
P EUBPIV ISION LOT BLOCK SIZE
O
O BUILDING IS TO BE FT. WIDE BY FT, LONG BY FT. IN HEIGHT AND SHALL CONFORM IN CONSTRUCTION
0
6
Z TO TYPE _USE GROUP BASEMENT WALLS OR UNOATION
a 0 r 7
0
0
k REMARKS: /2 Alta/ a
AREA OR
i ` "'-1 31.,La / ESTIMATED COST $ (3`i -- PERMIT e/y�t£'14
ei 4cu SOuuE TEETI V
OWNER .moi . �...,- (/////////,)//(/(T z�y BC OPT �1{1 ` ���� j�,r�R.{/'//1
ADDRESS !' ^' - �` 1— `�/. BYIAIA ] L�..�W'�
LI
(Affidavit on reverse side of applicotion to be completed by authorized agent of owner)
I hereby certify that the proposed work is authorized by the owner of record
and I hove been authorized by the owner to make this application as his
authorized agent.
SIGNATURE OF AGENT
ADDRESS
(NUMBER? (STREET) (CITY)
APPROVED BY TITLE
DATE 19_.
e
CITY OF NORTHAMPTON
OFFICE OF THE INSPECTOR OF BUILDINGS
212 MAIN STREET APPLICATION FOR
NORTHAMPTON, MA. 01060 (a - Cr PLAN EXAMINATION AND
/ BUILDING PERMIT
IMPORTANT - Applicant Ito complete all items in, Feed- 5
I, II,
Ill, IV, and IX. O
AT (LOCATION) ,S O. i'
�1 G. deWJv1�1< � n�-d DISTRICT �
u�
LOCATION (XO.) -J 'STREET) /
OF BETWEEN AND
BUILDING CROSS STREET/ (CROSS STREET)
LOT
SUBDIVISION LOT BLOCK SIZE _
U,
II. TYPE AND COST OF BUILDING - All applicants complete Parts A - D -d
A
A. TYPE OF IMPROVEMENT D. PROPOSED USE - For"wrecking" most recent use In
In
I ElNew building ResidAntial ✓ Nonresidential -i2 FT Addition(!/residential, enter number 12' tie 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
number of units— — — — —� 20 Industrial
3 I Alteration (See 2 above) 14 I I Transient hotel, motel, 21 Parkin
41 I Repair, replacement or dormitory — Enter number g garage
5 I I
enters Wrecking (b/multifamily residential,
of units y 22 Service station, repair garage
enter number of units in building in 151 l Garage 23 Hospital, institutional
Part D, 13)
16 I Carport 24 ,T. Office, bank, professional
6 I I Moving (relocation)
JJ Foundation only 17 Other — Specify 25 Public utility
26 School, library, other educational
B. OWNERSHIP \l 1A tINN m, q.3 OO� 27 Stores, mercantile
8 N Private (individual, corporation, %& r t 28 Tanks, towers
nonprofit institution, etc.) o A 3Z �Ue 29 J Other — Specify
9 Public (Federal, ate,
local
Femmant) 2
C. COST (Omit tents) Nonresidential — Describe in detail proposed use of buildings,e.g., food
2`i processing plant, machine shop, laundry building at hospital, elementary
10. Cost of improvement $ „} school, secondary
ondary school, college, parochial school, parking garage for
departmentstore, 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
o. Electrical
b. Plumbing
c.Heating, air conditioning
d. Other (elevator, etc.)
11. TOTAL COST OF IMPROVEMENT $ St`"
III. SELECTED CHARACTERISTICS OF BUILDING - For new buildings and additions, complete Parts E - L;
for wrecking, complete only Port J, for all others skip to IV.
E. PRINCIPAL TYPE OF FRAME G. TYPE OF SEWAGE DISPOSAL J. DIMENSIONS
at
3o Li Masonry (wall bearing) 401 Public or private company Number of stories
31 Wood frame 41 Private(septic tank, etc.) 49. Total square feet of floor area,
all floors, based on exterior
32 I Structural steel dimensions
33 LJ Reinforced concrete H. TYPE OF WATER SUPPLY
341 I Other - Specify 42 I Public or private company 50. Total land area, sq.ft
43 I I Private(well, cistern) K. NUMBER OF OFF-STREET
PARKING SPACES
F. PRINCIPAL TYPE OF HEATING FUEL I. TYPE OF MECHANICAL 51. Enclosed
351 I Gas Will there be central air 52. Outdoors
361 I Oil conditioning? L. RESIDENTIAL BUILDINGS ONLY
37 I I Electricity 44 I I Yes 45 I I No 53. Number of bedrooms
38 n Coal
39 1 I Other— Specify Will there be an elevator? 1 Full
54. Number of 1
46 I Yes 47 I No bathrooms
Partial
A _a,
MOTES and Data — (For department use)
IV. IDENTIFICATION - To be completed by all applicants
Name Mailing address - Number, street, city, and crate ZIP code Tel. No.
CRebeRiCkArCoRir � fze 7cFq-
Owner or 4ZAR\noWRikR. Coabctt .2sa I-iAJrlercui11w �A I e eel.) MRss 0103-3 73 V2'
Lessee
Builder's
2. FI O2fNCC Swim - License No.
Contractor
1/4300t
3.
Architect or
Engineer
I hereby certify that the proposed work is authorized by the owner of record and that I hove 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 .?sr.' Najderuin fIe Application dare
`13 Q e-a-kkezt Leeds, Mass o/°s3 37 /77
DO NOT WRITE BELOW THIS LINE
\V. PLAN REVIEW RECORD - For office use
Plans Review Required Check Plan Review Date Plans Date Plans ByNotes
quire Fee Started By Approved
BUILDING $
PLUMBING •
$
MECHANICAL $
ELECTRICAL •
$
OTHER $
VI. ADDITIONAL PERMITS REQUIRED OR OTHER JURISDICTION APPROVALS
Dote
Permit or Approval Check Obtained Number By Permit or A pprova I Check Dote
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 /1-2- 19 7
BuildingFire Grading
Th
Permit Fee $ /t5-G CI Live Loading
Certificate of Occupancy $ Occupancy Load
Apprgdad by: CM
Drain Tile
Plan Review Fee S yy,, 0
•
ITLE
VIII. ZONING PLAN EXAMINERS NOTES
DISTRICT
USE
FRONT YARD
SIDE YARD SIDE YARD
REAR YARD
NOTES
IX. SITE OR PLOT P}LAN$- For Applicant Use
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BOLA FORM APEBP 609 C1969 BuILeING OFFICIAL, 6 CODE ADM,xIO,'RpTORs ,x1EnupTIDxAL. IxF