11C-003 (2) " DEPT. OF'�BUILDING INSPECTIONS BUILDING o° /(7) , 66
�we_c).v
�:��- 212 Main Street ma-
-,_ Northampton, MA 01060 PERMIT
11C - 3 VALIDATION
689
DATE November 21 , 1189F1o8ence StReeds Owner
MIL
APPLICANT Edward Mikucki ADDRESS
INO.) (STREET) • (CONTR'S LICENSE(
PERMIT TO New Building (_) STORY Tool Shed NUMBER OF DWELLING UNITS
(TYPE OF IMPROVEMENT) NO. (PROPOSED USE)
AT (LOCATION)
118 Florence Street, Leeds ZONING
DISTRICT URA
(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: permit for the construction of a tool shed
AREA ESTIMATED COST $ 272.00 FEEMIT $ 10.00
VOOLUU ME E
(CUBIC/SQUARE FEET) 4�
OWNER Same as Applicant , n
`
'
BUILD] 11CARr
ADDRESS Same as Applicant's BY
WHITE - FILE COPY . GREEN - FIELD COPY • CANARY - APPLICANT COPY • PINK - ASSESSORS COPY PINTSIIP
VIII. ZONING PLAN EXAMINERS NOTES
DISTRICT
USE
FRONT YARD
SIDE YARD SIDE YARD
REAR YARD
NOTES
IX. SITE OR PLOT PLAN — For Applicant Use
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P INf.�4,P
NOTES and Data — (For department use)
f
4 �.
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IV. IDENTIFICATION — To be completed by all applicants
Name Mailing address — Number, street, city, and State ZIP code Tel. No.
1.
Owner or EOwr1-RD AA IKCietr1 /i$ f~'/.mQ <i. A -e-ocs
Lessee S7
Builder's
L.
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
-itiit ( 1 ql %r: _ //S QP , 'c, ,
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 Started Approved
BUILDING $
PLUMBING $
MECHANICAL $ ,
ELECTRICAL $
OTHER $
VI. ADDITIONAL PERMITS REQUIRED OR OTHER JURISDICTION APPROVALS
Date Permit or Approval Check Obtained 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
6
Permit number
Building Use Group
Permit issued 01-1' 19 F67
Building Fire Grading
Permit Fee $ O. Live Loading
Certificate of Occupancy $ Occupancy Load
Appr by:
Drain Tile $
Plan Review Fee $
TITLE
-art.',
, _... CITY OF NORTHAMPTON
MASSACHUSETTS
(11
ra OFFICE of the INSPECTOR of BUILDINGS
`'�' �'' Page e ! Plot ��
` � g l APPLICATION FOR
INSPECTOR ZONING PERMIT AND
BUILDING PERMIT
IMPORTANT — Applicant to complete all items in sections: I, II, Ill, IV, and IX. O
I. AT (LOCATION) f,'+( f�tellf/(STREET)
Ji. , / 1„`— 4� ZONING A
f 11 DISTRICT t-4_
LOCATION (NO., n C
OF BETWEEN A RC.s-'� �V, AND H-e F e ft AU o Ai _s
BUILDING (CROSS STREET) (CROSS STREET)
LOT
SUBDIVISION LOT BLOCK SIZE
N
II. TYPE AND COST OF BUILDING — All applicants complete Parts A — D —I
xi
A. TYPE OF IMPROVEMENT D. PROPOSED USE – For"Wrecking” most recent use m
m
1 K New building 9 Residential Nonresidential
2I 1 Addition(If residential, enter number 12 One family 18 I I Amusement, recreational
of new housing units added, if any,
in Part D, 13) 13 I I Two or more family – Enter 19 Li Church, other religious
number of units– – – – --). 20 LI Industrial
3 I I Alteration (See 2 above)
14 I I Transient hotel, motel, 21 [7 Parking garage
4 I I Repair, replacement or dormitory – Enter number
5 I Wrecking (If multifamily residential, of units – --31.- 22 r-1 Service station, repair garage
enter number of units in building in 15 I Garage 23 LL Hospital, institutional
Part D, 13)
16 Carport 24 Li Office, bank, professional
6 I I Moving (relocation) ^ / [/ ,
7 i I Foundation only 17 I I Other – Specify /(�'(,JL. 5./y4D 25 I 1 Public utility
/f '/ 26 Li School, library, other educational
B. OWNERSHIP 27 I Stores, mercantile
8 r Private (individual, corporation, 28 1.___1 Tanks, towers
7T nonprofit institution, etc.) 29 Li Other – Specify
9 1 I Public (Federal, State, or
local government)
C. COST (Omit cents) Nonresidential – Describe in detail proposed use of buildings, e.g., food
,y processing plant, machine shop, laundry building at hospital, elementary
10. Cost of improvement $ 1,/ j 0-i school, secondary school, college, parochial school, parking garage for,
f ///CCC��� 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 $.27 . (ft
III. SELECTED CHARACTERISTICS OF BUIL ING — 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 I I Masonry (wall bearing) 40 I 1 Public or private company
31 II Wood frame 41 I I Private (septic tank, etc.) 49. Total square feet of floor area,
all floors, based on exterior
32 I Structural steel dimensions
33 I I Reinforced concrete H. TYPE OF WATER SUPPLY
34 I I Other – Specify 42 Li Public or private company 50. Total land area, sq. ft.
43 [-1 Private (well, cistern) K. NUMBER OF OFF-STREET
PARKING SPACES
51. Enclosed
F. PRINCIPAL TYPE OF HEATING FUEL I. TYPE OF MECHANICAL
35 I I Gos Will there be central air 52. Outdoors
36I I Oil conditioning? L. RESIDENTIAL BUILDINGS ONLY
37 LII Electricity 44 L i Yes 45 XI No 53. Number of bedrooms
38 I I Coal
39 Li Other – .Specify /1/6'wf� Will there be on elevator" Full
t 54. Number of
46 h Yes 47 'x1 No bathrooms
Partial
}}' DEPT. OP BUILDING INSPECTIONS BUILDING /(} , 66
_j:c�,;i 212 Main Street is
Northampton, MA 01060 PERMIT a
11C - 3 VALIDATION
OWNER .�tamc. .�, <.�„r,_�.v--._—_ .. .., ,.. ...'�...� -RP()
ADDRESS _ Same as Applicant's BY
WHITE - FILE COPY . GREEN - FIELD COPY • CANARY - APPLICANT COPY • PINK - ASSESSORS COPY piNT Np
I' BUILDING IS TO BE FT. WIDE BY FT. LONG BY • •` •' ' •' • •`
TO TYPE USE GROUP BASEMENT WALLS OR FOUNDATION
}, (TYPE)
REMARKS: permit for the construction of a tool shed
AREA OR PERMIT
Ik VOLUME ESTIMATED COST $ 2'1....',:V FEE ,1;;).00
(CUBIC/SQUARE FEET) on Er' A
OWNER Same as Applicant BUILDING DEPT, +'
ADDRESS Same as Applicant's BY
WHITE - FILE COPY • GREEN - FIELD COPY • CANARY - APPLICANT COPY • PINK - ASSESSORS COPY pINT-4p
n
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