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IDENTIFICATION — To be completed by all applicants Name Moiling address — .vmbar, strcc•t, cif , urnrt SIa(c ZIP code Tel. No. Owner or Lessee Qui der's 2. � 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 D0 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 ApprovoI 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 L 1 Permit number Building q� Permit issued 64, �'C) 1980 Building GuroO Permit it Fee Certificate of Occupancy S Approved by: �\ Drain Tile Plan Review Fee _ V lw.J•L�..7C TITLE (Ctik of Nart4amptan - e� ,�Id448t1(1t4t114 Offirt of tht 'Nopertar 1,f jonilbings APPLICATION FOR Page 36 Plot t �¢ ZONING PERMIT AND BUILDING PERMIT IMPORTANT — Applicant to complete all items in sections: 1, 11, 111, IV, and IX. Z I• AT (LOCATION) a D ZONING STN CT LOCATION (NO.) (STREET) OF BETWEEN j 2--('t, f"AND BUILDING (CROSS STREET) (CROSS STREET) _ LOT SUBDIVISION LOT` i BL°'OCK SIZE 0 M 11. TYPE AND COST OF BUILDING — All applicants complete Parts -"D 7v A. TYPE IMPROVEMENT D. PROPOSED USE For••W r#g'st recem uyo� m 1 New building Resident I Nonresidential 2❑ Addition(If residential, enter number 12 One famil Y 18❑ Amussm t,recreational of new housing units added, if any, 13 Two or more family er 19 Ch they religious in Part D, 13) ❑ Y – v ❑ number o units– –– – 3❑ Alteration (See 2 above) / ­10'�-. 20❑ I ustrial 14❑ Transient hotel, motel, garage 4❑ Repair, replacement or dormitory – Enter number ❑21 Parking q a9 e Of units ––––––– – --1j. 22 Service station, repay ,� e 5❑ Wrecking (1J multi/amity residential, ❑ enter number of units in building in 15� Garage 23❑ Hospital, institutional " Part D, 13) 24❑ Office,bank, rofessi 6❑ Moving (relocation) 16❑ Carport p 17❑ Other – Specify 25❑ Public utility 7 F7 Foundation only 26 School,❑ library, other educational B. OWNERSHIP 27❑ Stores,mercantile 8 Private(individual, corporation, 28❑ Tanks,'towers nonprofit institution,etc.) 29❑ Other – Specify 9 ❑ Public(Federal, State,or p� local government) 113 C� p�g C. COST (Omit cents) Nonresidential – Describe in detail proposed use of buildings,e.g.,food 3S me to 1 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. 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.)............. O Cl 11. TOTAL COST OF IMPROVEMENT ;3I E3�3Q•� Ill. 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. y E. PRINCIPAL TYPE OF FRAME G. TYPE OF SEWAGE DISPOSAL J. DIMENSIONS 30❑I�psorKy(wall bearing) 40❑ Public or private company 48. Number of stories................ �;-2r 49. Total square feet of floor area, 31 Wood frame 41 rivofe{septic tank, etc.) all floors,based on exterior 32❑ Structural steel dimensions..................... fG 33❑ Reinforced concrete H. TYL;'P5� !MATER SUPPLY50. Total land area, sq.ft. ........... .3 1 0 O 34❑ Other – Specijy � fic or private company 43❑ Private(well, cistern) K. NUMBER OF OFF-STREET PARKING SPACES F. PRINCIPAL TYPE OF HEATING FUEL 1. TYPE OF MECHANICAL 51. Enclosed ....................... r O 35❑ Gas Will there be ce+rtral air 52. Outdoors........................ 36❑ I conditioning? L. RESIDENTIAL BUILDINGS ONLY 37 VEriectricity 44❑ Yes 45❑ No 53. Number of bedrooms.............. 38❑ Coal 39❑ Other– Specify Will there be an slevater? Full.......... " 54. Number of 46❑ Yes 47❑ No bathrooms Partial........ 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 as his authorized agent. e _ SIGNATURE OF AGENT ADDRESS (NUMBER) (STREET) (CITY)-, APPROVED BY TITLE DATE 19 - DEPARTMENT OF BUILDING INSPECTIONS io DEPT. FILE COPY 212 MAIN STREET NORTHAMPTON 9 MA. 01060 BUILDING Q IL 36 - 194 CODE #79 PERMIT VALIDATION DATE April 280 19 RO PERMIT NO. 210 APPLICANT Vhaadara T-uy4 ADDRESS 112 1 '&4"'Pr $t. (NO.) (STREET) (CONTR'S LICENSE) NUMBER OF 1 PERMIT TO Ne3g 1k.1P1lin —( ) STORY Ofle-familX residence DWELLING UNITS (TYPE OF IMPROVEM NT) NO. (PROPOSED USE) ZONING AT (LOCATION) Burts Pit Road DISTRICT SR (N0.) (STREET) a. BETWEEN Florence Rd AND Ryan Rd. m (CROSS STREET) (CROSS STREET) a m SUBDIVISION LOT BLOCK SIO E 125 X 250 28 FT. LONG BY FT. IN HEIGHT AND SHALL CONFORM IN CONSTRUCTION p BUILDING IS TO BE 52 FT, WIDE BY M Z TO TYPE USE GROUP BASEMENT WALLS OR FOUNDATION (TYPE) REMARKS: V21P-famit_,v residence with garage underneath- wood frame, electric heat, private sewage disposal, public water supply, 3 bedrooms, 2 full baths. AREA OR 1456 ESTIMATED COST $ 35#000 FEE MIT $ 105.00 VOLUME (CUBIC/SQUARE FEET) OWNER nnnAld Stiles B ADDRESS 56 P1 Paaant St.. Granby, Ma. B (Affidavit on reverse side of application to be completed by authorized agent of owner) 4 a r i „ � x P x w i , mt n so A .��, O �- �O ,� ` � �£� s.. �,` .�; — ��, ,r .� `fi r '�-� ��4� °s 54 Y..:' n�. ✓y 3 _.�°-=.. .g. A ¢. + ti� <T 5�ky� m .:. .... y,s kf� � a s p e �; �y� �,� �r � =��, �°y3f`,v, �"x`:�`S '��?� '�^. �.ri .� � � �x � � xr � sb; a�- A� r -�'�� a.. -^- gar ,,�