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NN... NOTES and Data — (For department use) �T) e M IV. IDENTIFICATION To be completed by all applicants Name Mailing address Number, -street, city, and State ZIP code Tel. No. Owner or r1 �.2 ti Lessee Builder's 2. ELL License No. Contractor 41 ' 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 applicarif A dress aTion date A p p I i c 0 0 NOT W R I T E BELOW T H I S L I N E 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 I$ OTHER i$ VI. ADDITIONAL PERMITS REQUIRED OR OTHER JURISDICTION APPROVALS Date Dote 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 Bui Idi:ng. Use Group Permit issued 19 Building Fire Grading Permit Fee $ Live Loading Certificate of Occupancy $ Occupancy Load Approved Drain Tile $ � l�=�" Plan Review Fee TITLE ' CITY OF NORTHAMPTON �. MASSACHUSETTS $ OFFICE of the INSPECTOR of BUILDINGS Page zzzr Plot APPLICATION FOR INSPECTOR ZONING PERMIT AND BUILDING PERMIT z IMPORTANT — Applicant to complete all items in sections: I, 11, 111, IV, and IX. O !' ZONING ////� I• AT (LOCATION)_ rS .,^ DISTRICTC.I�_ LOCATION (NO.) (STREET) OF BETWEEN +, -.- AND ',w: 41 BUILDING (CROSS STREET) (CROSS STREET) LOT SUBDIVISION LOT BLOCK SIZE N II. TYPE AND COST OF BUILDING — All applicants complete Parts A — D A. TYPE OF IMPROVEMENT D. PROPOSED USE - For"Wrecking" most recent use rn 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. .n Part D, 13) 13 ❑ Two or more family - Enter 19❑ Church, other religious number of units- - - - -o. 20❑ Industrial 3 ` Alteration (See 2 above) _ 14 ❑ Transient hotel, motel, 21 parking garage 4 Repair, replacement or dormitory - Enter number 5 El Wrecking (It 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) 17 ❑ Other - Specify 25❑ Public utility 7 ❑ 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 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,,,,,,,,,,,,,,,, �/� I) 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 $ 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 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 there be central air 52. Outdoors........................ 36 ❑ Oil conditioning? L. RESIDENTIAL BUILDINGS ONLY 37 C_� Electricity 44 ❑] Yes 45 ❑ No 53. Number of bedrooms.............. 38 ❑ Coal 39 ❑ Other - Specify Will there be an elevator" Full.......... 54. Number of 46 ❑ Yes 47 ❑ No bathrooms Partial........ . y DEPT. OF BUILDING INSPECTIONS BUILDING Z° 212 Main Street oa $10.00 Northampton, MA 01060 PERMIT 17A - VALIDATION X34- DATE July 23, 2 PERtyj NO. 433 APPLICANT QGeorge Dastous ADDRESS (� S arms �t((QQ (NO.) (STREET) (CONTR'S LICENSE) Alteration Porch Roof NUMBER OF PERMIT TO (_) STORY DWELLING UNITS (TYPE OF IMPROVEMENT) NO. (PROPOSED USE) Lake Streetq klor ence ZONING 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 to put roof over open deck AREA OR 800.00 PERMIT 10.00 VOLUME 55 sq. ft. ESTIMATED COST $ FEE $ (CUBIC/SQUARE FEET) OWNER Dorothy Berube ADDRESS 86 Lake Street, Florence BYILDIN WHITE - FILE COPY . GREEN - FIELD COPY • CANARY - APPLICANT COPY • PINK - ASSESSORS COPY P'ixf' IiP