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NOTES and Data — (For department use)
IV. IDENTIFICATION — To be completed by all applicants
Name Mailing address — Number, street, city, anti .State ZIP code Tel. No.
Owner or
Lessee
Builder's
2.
License No /✓ �� ��
Controctor p
00 6 76
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.
Signattirf of licant 7 ' Address Application date
L.Jai t Q
,/. 00 NOT WRITE BE 0W THIS LINE
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
Permit or Approval Check Date Number B Permit or Approval Check Date Number B
Obtained y pp Obtained 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
11. VALIDATION
Building t� i FOR DEPARTMENT USE ONLY
Permit number l t
Bui Iding. Use Group
Permit issued �� 19 26
Building Fire Grading
Permit Fee $ $'0.00
Live Loading
Certificate of Occupancy $ Occupancy Load
Approved by:
Drain Tile $
Plan Review Fee $
TITLE
CITY OF NORTHAMPTON
�+ MASSACHUSETTS
$ OFFICE of the INSPECTOR of BUILDINGS
Page 3ac Plot ` APPLICATION FOR
INSPECTOR ZONING PERMIT AND
BUILDING PERMIT
z
IMPORTANT — Applicant to complete all items in sections: I, 11, III, IV, and IX. O
x/ Ale. ZONING
I• AT (LOCATION)/'/ / 0 `A r/cryy /✓ll . _ __ ZONIN CT��
LOCATION if[ : (NO') ` REET)
(J T J- -)/
OF BETWEEN ' /".5��e'c= AND
BUILDING r�� (C SS STREET) (CROSS STREET)
LOT
SUBDIVISION LOT BLOCK SIZE
N
II. TYPE AND COST OF BUILDING — All applicants complete Parts A — D A
A. TYPE OF IMPROVEMENT D. PROPOSED USE - For"Wrecking" most recent use m
m
1 ❑ N w building Residentia Nonresidential
2 Addition(1/ residential, enter number 12 ne 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- - - - -). - -1�ausiricl
3 ❑ Alteration (See 2 above)
14 Transient hotel, motel,
4 ❑ Repair, replacement 2) ❑ Parking garage
p p or dormitory - Enter number
5 ❑ Wrecking (If multifamily residential, of units ------- - -► 22 Service station, repair garage
enter number of units in building in 15 ❑ Garage 23 ❑ Hospital, institutional
Part D, 13) ❑
16 Carport 24 E] Office, bank, professional
6 ❑ Moving (relocation)
17❑ Other - Speci/y 25❑ Public utility
7 ❑ Foundation only
26 ❑ School, library, other educational
B. OWNERSHIP 27❑ Stores, mercantile
8 rivote (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
processing plant, machine shop, laundry building at hospital, elementary
10. Cost of improvement,,,,,,,,,,,,,,,, cc 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.....................
b. Plumbing .....................
c. Heating, air conditioning........
d. Other(elevator, etc.)............
11. TOTAL COST OF IMPROVEMENT I$ *000:C) )
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❑ Masonry (wall bearing) 40 li
ubc or private company
31 i ood frame 41 ❑ Private (septic tank, etc.) 49. Total square feet floor area,
all floors, based on exterior
32❑ Structural steel dimensions ..................... 3,.....................
33❑ Reinforced concrete H. TYPE OF WATER SUPPLY
34 ❑ Other - Specify 42 ublic or private company 50. Total land area, sq. ft. ...........
43 ❑ Private (well, cistern) K. NUMBER OF OFF-STREET
PARKING SPACES
51. Enclosed .......................
F. PRINCIPAL TYPE OF HEATING FUEL I. TYPE OF MECHANICAL
35 as Will there be central air 52. Outdoors........................
36 Oil conditioning?
�7 L. RESIDENTIAL BUILDINGS ONLY
37 El Electricity 44 [-_] Yes 45 K rvo 53. Number of bedrooms..............
38 ❑ Coal
39 ❑ Other - Specify Will there be an elevator? Full..........
- 54. Number of
46 ❑ Yes 47 EE ��q bathrooms
Partial........
e DEPT. OF BUILDING INSPECTIONS BUILDING °-
+ 212 Main Street OIL x oo
Northampton, MA 01060 PERMIT
32C - 154 VALIDATION
DATE October 15, Ig 86 PERMIT NO. 610
APPLICANT Walter Dziubek & son ADDRESS P.O. ,Box 38, Florence 008764
(NO.) (STREET) (CONTR•S LICENSE)
OF
Addition One Family Dwelling DWELLR
PERMIT TO STORY
DWELLING NUMBER I_)
(TYPE OF IMPROVEMENT) NO. (PROPOSED USE)
ZONING
AT (LOCATION)
18 Kingsley Ave DISTRICT URC
(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 addition of a family room onto existing siAAle family dwelling
AREA OR PERMIT
VOLUME 320 sg f t. ESTIMATED COST ���nn�_nn FEE .� 80.00
ICUSIC/SQUARE FEET)
OWNER Al Touch ttP BUILD A
ADDRESS 18 Kingsley Avp- - Nnrthamntnn BY
WHITE - FILE COPY . GREEN - FIELD COPY • CANARY - APPLICANT COPY • PINK ASSESSORS COPY p'INT IIP