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IV. IDENTIFICATION — To be completed by all applicants Name Mailing address — Number, strut, city, and State ZIP code Tel. No. 1. Owner or Lessee Builder's 2. Jil License No. Contractor Architect t; 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 Plans Review Required Check Plan Review Date Plans B Date Plans By Notes Fee Started y Approved BUILDING PLUMBING MECHANICAL ELECTRICAL OTHER VI. ADDITIONAL PERMITS REQUIRED OR OTHER JURISDICTION APPROVALS Date )ate 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 Building i Use Group Permit issued 4Z 19/ Building /` Fire Grading Permit Fee $ v ' Live Loading Certificate of Occupancy Occupancy Load Appr7d by: �l Drain Tile Plan Review Fee TITLE r ' NOTES and Data — (For department use) CITY OF NORTHAMPTON OFFICE OF THE INSPECTOR OF BUILDINGS 212 MAIN STREET APPLICATION FOR NORTHAMPTON, MA. 01060 PLAN EXAMINATION AND �� 2,2_ BUILDING PERMIT z IMPORTANT — Applicant to complete all items in sections: 1, 11, 111, IV, and IX. 0 ��4 ( 7° ZONING ��2 I• AT (LOCATION) ,? �J Z DISTRICT LOCATION (N0.) (STREET) OF t yJ//� �C �%� °3S BETWEEN l:� /1( AND BUILDING iz (CROSS STREET) (CROSS STREET) LOT SUBDIVISION LOT BLOCK SIZE V► II. TYPE AND COST OF BUILDING — All applicants complete Parts A — D X A. TYPE OF IMPROVEMENT D. PROPOSED USE — For"Wrecking" most recent use M M 1 ❑ New building Residential Nonresidential 2 ❑ Addition(If 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 /1 19 ❑ Church, other religious 3 ❑ Alteration (See 2 above) number of units— — — — -- 20❑ Industrial 14 Transient hotel, motel, 21 ❑ Parking garage 4 ❑ Repair, replacement or dormitory — Enter number 5 KWrecking (If multifamily residential, of units ——————— — -i 22 ❑ Service station, repair garage enter number of units in building in 15 Garage 23 ❑ Hospital, institutional Part D, 13) r❑ 16 l Carport 24 ❑ Office, bank, professional 6 ❑ Moving (relocation) 7 ❑ Foundation only 17�❑ Other — Specify 25 ❑ Public utility 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 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•,,,,•••••,,,,,• 4 >, school, secondary school, college, parochial school, parking garage for, department store, rental office building, office building of 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..................... 140X tl- C_�1`/ C //7(i '✓(�%C Cf /r1Ci b. Plumbing ..................... c'cw S c. Heating, air conditioning.......... d. Other (elevator, etc.)............ A_"11 1 Cl ifi L' 11. TOTAL COST OF IMPROVEMENT $ ao'Gr� 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, all floors, based on exterior 32 ❑ Structural steel dimensions ..................... 1 /� 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 F. PRINCIPAL TYPE OF HEATING FUEL I. TYPE OF MECHANICAL 51. Enclosed ...................... 35 XGos Will there be central air 52. Outdoors........................ 36 conditioning? L. RESIDENTIAL BUILDINGS ONLY 37 44 ❑ Yes 45 ❑ No 53. Number of bedrooms.............. 38 39 Will there be on elevator? Full.......... 54. Number of 46 ❑ Yes 47❑ No bathrooms Partial....... t ; 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, as his authorized agent. SIGNATURE-OP AGENT ADDRESS (NUMBER) (STREET) (CITY) APPROVED BY TITLE DATE 19 . , DEPT. FILE COPY ZO CITY OF NORTHAMPTON BUILDING a a PERMIT VALIDATION NORTHAMPTON, MA. 17A — 229 DATE July 12, 19 78 NO. 276 APPLICANT Robert M Beaimre ADDRESS 101 & 103 Lake Street (NO.) (STREET) (CONTR'S LICENSE.) NUMBER OF PERMIT TO Demolition cg CnY14tY=(_f_) STORY Aux Bldg DWELLING UNITS 2 (TYPE OF IMPROVEMENT) NO. (PROPOSED USE) ZONING Lake St P+l n T URB AT (LOCATION) 10 y DISTRICT � (N0.) (STREET) a BETWEEN North Maple AND 0 k b (CROSS STREET) (CROSS STREET) LOT a SUBDIVISION LOT BLOCK SIZE m U BUILDING IS TO BE 12 FT. WIDE BY 12 FT. LONG BY FT. IN HEIGHT AND SHALL CONFORM IN CONSTRUCTION m Z TO TYPE USE GROUP BASEMENT WALLS OR FOUNDATION � (TYPE) 0: LL REMARKS; Demolition of existing building and const of steel aux building AREA OR 'I PERMIT VOLUME 144 4 ESTIMATED COST $ 4=DE FEE (CUBIC/SQUARE FEET) OWNER Rnb px� + Real re .ADDRESS 101 & 10� Take St,� Fl nrenre (Affidavit on reverse side of application to be completed by authorized agent of owner)