31B-185 (5) Department of Building Inspections
212 Main Street
Northampton, Mass!. -2'31060 BUILDING ,e glo•oo
31B - 185 04
PERMIT
VAL OAT ON
DATE July 10, 19 84 PERMIT NO. 294
APPLICANT Louis Rolling ADDRESS 101 StSfP SYYPP}
(NO.) (STREET) ICONTR S LICENSE(
AlterationNUMBER OF
PERMIT TO 1_) STORY Three Family Fri CH DWELLING UNITS
Inn OF LRROVEMEXTI 0. (PROPOSED
FO VSE1
AT I LOCAT ION 103 State Straar ZONING
DISTRICT IRC
IRO.) (STREET(
BETWEEN AND_
(CROSS STREET) (CROSS STREET)
LOT
SUBDIVISION LOT BLOCK SIDE
BUILDING 15 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 close in exp 'n p h
$
AREA OR
VOLUME ESTIMATED COST 2,000.00 PERMIT 10.00
(CUBIC/SQUARE FEET)
OWNER Jeffrey Gollin• /
.4112
103 State St. , Northampton, Mass. 01060 BUI %)' 'I - -
ADDRESS BY
WHITE - FILE COPY • GREEN - FIELD COPY • CANARY - APPLICANT COPY • PINK - ASSESSORS COPY
'`C y ie. _ CITY OF NORTHAMPTON
MASSACHUSETTS
r
OFFICE of the INSPECTOR of BUILDINGS
ate Page 13 Plot /SS APPLICATION FOR
ZONING PERMIT AND
INSPECTOR BUILDING PERMIT
IMPORTANT - Applicant to complete all items in sections: I, II, III,IIV, and IX. o
AT (LOCATION) 10 7J STAT L SM: a E I
ZONING
IISTA C���
LOCATION ' (NO.) ISTREETI
OF BETWEEN AND
BUILDING (CROSS STREET, (CROSS STREET)
LOT
SUBDIVISION LOT BLOCK SIZE
II. TYPE AND COST OF BUILDING - All applicants complete Parts A - 0 -i
Al
A. TYPE OF IMPROVEMENT D. PROPOSED USE - For"Wrecidng•' most recent use In
m
-I
1 I I New building Residential Nonresidential
21 I Addition(I/ renter flambee 12 L] One family 10 [ 1 Amusement, recreational
of new housng units added, i/any. Two or more family Part D, 13) 13 TJy - Luer p 19 1 I Church, other religious
number of units- - - - -0.J— 20 Li Industrial
3 Alteration (See 2 above) 14 1 1 Transient hotel, motel,
4 Repair, replacement or dormitory - Enter number 21 Parking garage
5 I 11 Wrecking (II multifamily residential, 0/ units -y 22 L J Service station, repair garage
enter number of units in building in 15 I 1 Garage 23 r i Hospital, institutional
Part D, 13)
16 24I I Office, bank, professional
6 L] Moving (relocation) Carport
Foundation only 17 I I Other - Specify 25 El Public utility
261 I School, library, other educational
B. OWLL 27 J Stores, mercantile
B 4 Private individual, corporation,r 201 Tanks, towers
nonprofitins ion, etc() 29 Other - Specify
9 1 j Public(Federal,State, or
local government)
C. COST (Omit cents) Nonresidential - Describe in detail proposed use of buildings,e.g., food
y processing plant, machine shop, laundry building at hospital,elementary
L
10. Cost of improvement g U d C. 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. Plumb) g
c. Heating, air conditioning
d. Other (elevator, etc ) rr�s _� �
it. TOTAL COST OF IMPROVEMENT S leo —
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 C Masonry (wall bearing)
40 i I 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 7 Structural steel dimensi
331 I Reinforced concrete H. TYPE OF WATER SUPPLY
341 Other - Specify 42 I Public or private company 50. Total land area, sq. ft.
431 Private (well, cistern) K. NUMBER OF OFF-STREET
PARKING SPACES
F. PRINCIPAL TYPE OF HEATING FUEL I. TYPE OF MECHANICAL 51. Enclosed
151 Gas Will there be central air 52. Outdoors
36 0iI condition(regi L. RESIDENTIAL BUILDINGS ONLY
37 Electricity 44 rJ Yes 45.>.< No 53. Number o1 bedrooms
38 Coal
39 , ', Other- tpurify Will there be o'i elevator' cauill
rr.
54.
Number of
46 � Yes 47 ±j No bathrooms
IV. IDENTIFICATION — To be completed by all applicants
Narne Mailing address — ,Number, sure , ray, and Stew. ZIP code Tel. No.
o.,
t. ��(--
ne. o, .�e F/=liE% /p .STA it= 5 j O/066
Lessee ceL-L//v4 war< T/1A /o1ToH / `4 Ass 1636
Builder's
Lmense No.
Contractor
3.
Architect or
Engineer
I hereby certify that the proposed work is authorized by the owner of record and that I hove been authorized by the owner to
make this application as his authorized agent and we agree to conform to all applicable lows of this jurisdiction.
Signature of applicant/' Address Application dote
�� . .., / o3 5 4i
DO NOT WRITE BELOW THIS LINE
V. PLAN REVIEW RECORD — For office use
Plans Review Required Check Plan Review Date Plans ByDate Plans ByNotes
guir` Fee Started Approved
BUILDING $
PLUMBING $
MECHANICAL $
ELECTRICAL $
OTHER $
VI. ADDITIONAL PERMITS REQUIRED OR OTHER JURISDICTION APPROVALS
Dae Dote
Permit or Approval Check Obto ned 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
Buildingq t4 FOR DEPARTMENT USE ONLY
Permit number
Building- //�l Use Group
Permit issued LC/ 19at
Fire Grading
Building /U &O
Permit Fee $ U Live Loading
Certificate of Occupancy $ Occupancy Load
Approved b
Drain Tile $
Plan Review Fee $ �
TITLE
NOTES and Data — (For department use)
•
AAI atikr.
VIII. ZONING PLAN EXAMINERS NOTES
DISTRICT
USE
FRONT YARD
SIDE YARD
SIDE YARD
REAR YARD
NOTES
IX. SITE OR PLOT PLAN — For Applicant Use
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