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IDENTIFICATION — To be completed by all applicants Name Mailing address — Number, street, city, and State ZIP code Tel. No. Owner or i {/" � W!X1 b�---'�/. G�V�OQ a Lessee CA Builder's 2. License No. Contractor vcrf3r 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 applico Address Application d to � � 00 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 $ V1. ADDITIONAL PERMITS REQUIRED OR OTHER JURISDICTION APPROVALS Date Permit or Approval Check Obttai ed Number By Permit or Approval Check Obttoitned 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 1 Building. ..// Use Group Permit issued 7' 19W per}L Building Fire Grading Permit Fee �0 1 40 Live Loading Certificate of Occupancy $ Occupancy Load Ap roved by: r Drain Tile $ Plan Review Fee $ TITLE CITY OF NORTHAMPTON �• MASSACHUSETTS $ OFFICE of the INSPECTOR of BUILDINGS ,�. Page '?`T�' Plot y'S� APPLICATION FOR INSPECTOR ZONING PERMIT AND BUILDING PERMIT IMPORTANT — Applicant—to�n/complete all items in sections: 1, 11, 111, IV, and IX. /�/� O I• AT (LOCATION) 3�3 O'• '-_Tom"" - ZONING CT4lt/Z ' LOCATION (No.) (STREET) OF BETWEEN AND BUILDING (CROSS STREET) (CROSS STREET) LOT SUBDIVISION LOT BLOCK SIZE 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 Residential Nonresidential 2 ® Addition(1/residential, enter number 12 One 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- - - - -� 20 ❑ Industrial 3 ® Alteration (See 2 above) 14 ❑ Transient hotel, motel, 21 ❑ Parking garage 4 ❑ Repair, replacement or dormitory - Enter number 5 ❑ Wrecking (11 multifamily residential, of units ------- - -- 22 ❑ Service station, repair garage enter number of units in building in 15 ❑ Garage 23 L❑ Hospital, institutional Part D, 13) 16 Carport 24 ❑ Office, bank, professional 6 ❑ Moving (relocation) p 17❑ Other - SpeciJy 25 ❑ Public utility 7 ❑ Foundation only 26 ❑ School, library, other educational B. OWNERSHIP 27 L❑ Stores, mercantile 8 Private (individual, corporation, 28 ❑ Tanks, towers nonprofit institution, etc.) 29 L❑ Other - Specify 9 ❑ Public (Federal, State, or local government) C. COST (Omit cents) Nonresidential - Describe in detail proposed use of buildings, e.g., food n processing plant, machine shop, laundry building at hospital, elementary 10. Cost of improvement,,,,,,,,,,,,,,,, 4V C3 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 $ 2Za v 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 F-] Masonry (wall bearing) 40 Public or private company 48. Number of stories.............. 31 Wood frame 41 � Private (septic tank, etc.) 49. Total square feet floor area, all floors, based on exterior 32 ❑ Structural steel dimensions ..................... 33 ❑ Reinforced concrete H. TYPE OF WATER SUPPLY 34 ❑ 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 th be central air 52. Outdoors........................ .3 36 Oil conditionin 37 ❑ Electricity 44 �� Yes 45 ❑ No L. RESIDENTIAL BUILDINGS ONLY rr�� 53. Number of bedrooms.............. v/ 38 ❑� Coal / 39 ❑ Other - Specify Will ther e an elevators Full...(...... 54. Number of 46 Yes 47 ❑� No bathrooms Partial........ Department of Building Inspections 212 Main Street BUILDING Z Northampton, Ma. 01060 oa /�f 25C — 145 PERMIT �a /U VALIDATION DATE JaMlAry 14 19 63 PERMIT NO. 7m" QZ/ APPLICANT Yoyi., f blotto ADDRESS 68 union St_ _ N'tnn� 001317 (NO.) (STREE�— (CONTR'S LICENSE) NUMBER OF PERMIT TO (7_) STORY DWELLING UNITS 1 (I?qff OVEMENT) NO. (PROPOSED USE) ZONINGS AT (LOCATION) 3,3_ Orchard 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: Pytena7 back porch roof for Car=Art 151 X In': mi AC. changes in Awelling, replace windows. AREA OR 270n-no FEE MIT 10-00 VOLUME ESTIMATED COST 7 (CUBIC/SQUARE FEET) OWNER ,jaxy4Q & r1autijA EA Hnftas BUILDI��� ADDRESS 3" Orchard St*eA*; A�t ampten- a- DY WHITE - FILE COPY . GREEN - FIELD COPY • CANARY - APPLICANT COPY ■ PINK - ASSESSORS COPY