23D-004 (7) �. DEPT. FILE COPY
CITY OF NORTHAMPTON °
212 MAIN STREET BUILDING
X EL
NORTHAMPTON MA. 01060 23D-4 PERMIT
VALIDATION
DATE December 28, is 78 PERMIT NO. 625
APPLICANT nevi c1 R TPPRP ADDRESS 15 NOncrictk St. Fln
(NO.) (STREET) (CONTR'S LICENSE)
PERMIT TO Alter Residence (_) STORY Residence NUMBER of
DWELLING UNITS 1
(TYPE OF IMPROVEMENT) NO. (PROPOSED USE)
AT (LOCATION) 15 Nonotuck ZONING
(NO.) (STREET) DISTRICT URB
a BETWEEN Soi th Main AND Nonntnnk
a (CROSS STREET). (CROSS STREET)
m SUBDIVISION LOT BLOCK SIZE
a
u
O BUILDING IS TO BE FT. WIDE BY FT. LONG BY FT. IN HEIGHT AND SHALL CONFORM IN CONSTRUCTION
m
0
Z TO TYPE USE GROUP BASEMENT WALLS OR FOUNDATION
(TYPE)
O
a REMARKS: A11-.Pr rPRI(3AnnA pRr app)l natal nn
AREA OR ESTIMATED COST $ 2225.00 FEE $ 10.00
VOLUME PERMIT
(CUBIC/SQUARE FEET)
OWNER T)avi C3 F. TAAnP.
BUI I T.
ADDRESS 15 No-no-hunk St. , Fl nrPno , Ma. BY
(Affidavit on reverse side of application to be completed by authorized agent of owner)
I hereby certify that the proposed work is authorized by the owner of record
and I have been authorized by the owner to make this application a`s his
authorized agent.
SIGNATURE OF `AGENT
ADDRESS
(NUMBER) (STREET) (CITY)
APPROVED BY TITLE
DATE 19 .
•
CITY OF NORTHAMPTON
OFFICE OF THE INSPECTOR OF BUILDINGS
3b
212 MAIN STREET ° APPLICATION FOR
NORTHAMPTON, MA. 01060 PLAN EXAMINATION AND
BUILDING PERMIT
IMPORTANT — Applicant to complete all items in sections: I, II, Ill, IV, and IX. 0 t
I• AT (LOCATION) 1 0 4—UCIC 5�
DISTRICT
LOCATION (NO.) (STREET) n� —r}
OF BETWEEN �P�L�4� r -t Al 6Q J± AND ,�+0�`�U i V
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 m
m
1 I I New building Residen ial Nonresidential
2 I I Addition(If residential, enter number 12�✓One family 18 j Amusement, recreational
of new housing units added, if any,
in Part D, 13) 13 I Two or more family — Enter 19 I Church, other religious
number of units— — — — 20 I Industrial
3 I Alteration (See 2 above)
14 I Transient hotel, motel,
4 I I Repair, replacement or dormitory — Enter number 21 I Parking garage
5 I I Wrecking (If multifamily residential, of units — —30- 22 Service station, repair garage
enter number of units in building in 15 I I Garage 23 I Hospital, institutional
Part D, 13) 24 I Office, bank, professional
16I Carport
6I I Moving (relocation)
7 I Foundation only 17 I Other — Specify 25 Public utility
26 I School, library, other educational
B. OWNERSHIP 27 I Stores, mercantile
8 Irivate (individual, corporation, 28 Tanks, towers
nonprofit institution, etc.) 29 I Other — Specify
9 I I Public (Federal, State, or
local government)
C. COST (Omit cents) Nonresidential — Describe in detail proposed use of buildings, e.g., food
cye processing plant, machine shop, laundry building at hospital, elementary
10. Cost of improvement $ IPr7 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 Z�
a. Electrical
b. Plumbing
c. Heating, air conditioning
IOC) r
d. Other(elevator, etc.)
11. TOTAL COST OF IMPROVEMENT $ 5
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
30[ j Masonry (wall bearing) 40 I I Public or private company Number of stories
31 I 49. Total square feet of floor area,
Wood frame 41 I I Private (septic tank, etc.) all floors, based on exterior
32 I I Structural steel dimensions
33 I I Reinforced concrete H. TYPE OF WATER SUPPLY
34 I 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
35 I I Gas Will there be central air 52. Outdoors
36 I I Oil conditioning?
L. RESIDENTIAL BUILDINGS ONLY
37 I Electricity 44 I I Yes 45 I I No 53. Number of bedrooms
38 I I Coal
39 I I Other— Specify Will there be an elevator?
Full
54. Number of
46 I I Yes 47 I I No bathrooms Partial
NOTES and Data — (For department use)
IV. IDENTIFICATION — To be completed by all applicants
Name Mailing address — Number, street, city, and State ZIP ZIP code Tel. No.
1. —TEZC� 15 (VOcti.roR,C f."_1Or /UCH L I S . OLOG O sBtf
Owner or
Lessee I ZC,
Lit c� Builder's (�
2. lit" �*1 1 .�SOAd ZdC'1 �O 1� 14. 1�lZTY •L ' A S License No. S13
Contractor
ya� l
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_au.thorized agent and we agree to conform to all applicable laws of this jurisdiction.
t Signature of Qpplic nt Address t f Application date
UCLA-3U �,c_ c_t_ /C. /tinkoX 514-,
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 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
Permit number 6,2S-
Building Use Group
Permit issued _ .�2', 19
Building Fire Grading
Permit Fee $ /e.
Live Loading
Certificate of Occupancy Occupancy Load
Ap rf,J by:
Drain Tile 11
Plan Review Fee
TITLE