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NOTES and Data — (For department use)
IV. IDENTIFICATION — To be completed by all applicants
Name t Mailing address — Number, stmt, city, and State ZIP code Tel. No.
1. - Pc d u� T �� r15 4 / Q
Owner or 1J1, �' 1 Ct:-- J�f� u. U!(;�U
Lessee / y u
l'4ti IG'�%' Builder's
2. '%f I3
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
00 NOT WRITE BELOW THIS LINE
V. PLAN REVIEW RECORD — For office use
Plan Review Date Plans Date Plans
Plans Review Required Check Fee Started By Approved By Notes
BUILDING $
PLUMBING $
MECHANICAL $
ELECTRICAL $
OTHER $
VI. ADDITIONAL PERMITS REQUIRED OR OTHER JURISDICTION APPROVALS
Permit or Approval Check ObttaT ed 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 /Q� FOR DEPARTMENT USE ONLY
Permit number _ ^
Bui Iding / Use Group
Permit issued _ '�/ 19
Building // Fire Grading
Permit Fee $ / (_
Live Loading
Certificate of Occupancy $ ,Occupancy Load
Approved .!
Drain Tile $
Plan Review Fee
TITLE
CITY OF NORTHAMPTON
.� MASSACHUSETTS
r
$ e OFFICE of tbie INSPECTOR of BUILDINGS
Page Plot q APPLICATION FOR
ZONING PERMIT AND
INSPECTOR BUILDING PERMIT
IMPORTANT — Applicant to complete all items in sections: 1, 11, 111, IV, and IX. O
I•
ZONING
AT (LOCATION) ��1 V�1J DISTR CT
LOCATION (NO.) fl (STREET) `I �1
OF BETWEEN 10 kA/ AND Mf'�,V itC,:,.y//
BUILDING (CROSS STREET) (CROSS STREET)
LOT
SUBDIVISION LOT_ BLOCK SIZE
H
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 ❑ New building Re id ntiol Nonresidential
2 Addition residential, enter number
❑ 12 One family 18 ❑ Amusement, recreational
of neu., housing units added, if any,
in Part D, 13) 13 Two or more family - Freter 19 Church, other religious
3 ,Alteration (.See 2 above)
number of units- - - - i 20 Industrial
.
14 ❑ Transient hotel, motel, 21 Parking garage
4 Repair, replacement or dormitory - Fnter number
❑ o units - - --� 22 L_ j Service station, repair garage
5 Wrecking (If multifamily residential, / _
enter number of units in building in 15 Garage 23 �_ Hospital, institutional
Part D, 73)
� 16 �� Carport � 24 � � Office, bank, professional
6 Moving (relocation)
7 Foundation only 17 Other - Specify�G� 25 �� Public utility
26 _J School, library, other educational
B. OWNERSHIP 27 Stores, mercantile
8 Private (individual, corporation, f' 28 , Tanks, towers
)
nonprofit institution, etc.) 29 ❑ Other - Speci fy
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,,,•,,,,,•,,.... $ " school, secondary school, college, parochial school, parking garage for,
department store, rental office building, office building at industrial plant.
7'o 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 $ r
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 ❑ Masonry (wall bearing) 40 Public or private company 48. Number of stories................
31 ❑ Wood frame 41 Private (septic tank, etc.) 49. Total square feet of floor area, 1
- - all floors, based on exterior
32 ❑ Structural steel dimensions ..................... '
33 ❑ Reinforced concrete H. TYPE OF WATER SUPPLY
34 L❑ Other - Specify 42 ❑ Public 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 [, Gas Will there be central air 52. Outdoors........................
t_,
conditioning?
36 [ ] Oil L. RESIDENTIAL BUILDINGS ONLY
37 L.: Electricity 44 Yes 45 _ No 53. Number cf bedrooms..............
38 Coal
39 Other - Spcci/y Will there be an elevator" Full..........
54. Number of
46 � ) Yes 47 --1 No bathrooms Partial........
w y
a DEPT. OF BUILDING INSPECTIONS BUILDING z° ,
212 Main Street o<
Northampton, MA 01060 PERMIT <a
36 - 99 VALIDATION
DATE Owner
August 2, 9 88 PE IT N 492
APPLICANT Ed Popielarczyk ADDRESS 81 ur S Pit d. ,
(NO.) (STREET) (CONTR'S LICENSE)OF
Above Ground Pool One Family DWELLR
PERMIT TO (_) STORY
ING UNITS
(TYPE OF IMPROVEMENT) NO. (PROPOSED USE)
981 Burts Pit Road ZONING UKA
AT (LOCATION) DISTRICT
(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 installation of an above ground pool 24' diameter
AREA OR 24' diameter 3 000 00 PERMIT 10.00
VOLUME ESTIMATED COST FEE .
(CUBIC/SQUARE FEET)
OWNER Same as ADplicant BUILD)
E
ADDRESS Same a$ ADpl Kant' S BY
a
WHITE - FILE COPY . GREEN - FIELD COPY ■ CANARY - APPLICANT COPY • PINK -/ASSESSORS COPY pjNf NP