23D-107 (22) 4 }j "•a DE . OF BUILDING INSPECTIONS BUILDING ° ZO .�`\�
; t �Ie 212 Main Street oa �I
' DEFT..
Northampton, MA 01060 PERMIT4
23D - 107 VALIDATION
DATE March 7, 19 85 PERMIT NO. 103
APPLICANT John A. Smith ADDRESS 548 Elm Street
(NO.) (STREET) (CONTR•S LICENSE)
Alteration NUMBER OF
PERMIT TO I_) STORY Nursing Home DWELLING UNITS
(TYPE OF IMPROVEMENT) NO. (PROPOSED USE)
548 Elm Street ZONING URB
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 add new partitons
AREA OR VOLUME ESTIMATED COST 51,000.00 PEP." $O•00
(CUBIC/SQUARE FEET) ")
OWNER Pioneer Valley Nursing HOme �(/,��y
BUILDIN il�'4/ �� Z��
ADDRESS 548 Elm St. , NnrthamPtnn BY �jJJ��L/
WHITE - FILE COPY . GREEN - FIELD COPY • CANARY - APPLICANT COPY • PINK - ASSESSORS COPY pINTSIIp
,- . CITY OF NORTHAMPTON
VIII. ZONING PLAN EXAMINERS NOTES fr
ft At`-I lk . MASSACHUSETTS
107. . J�::i "ra - OFFICE of the INSPECTOR of BUILDINGS
oi
DISTRICT V r =`�cjr �-
as Page Plot ��� APPLICATION FOR
USE INSPECTOR ZONING PERMIT AND
BUILDING PERMIT
FRONT YARD
' IMPORTANT — Applicant to complete all items in sections: I, II, Ill, IV, and IX. 0
SIDE YARD SIDE YARD I. AT (LOCATION) 544 L"M D O I NJi r J
REAR.YARD LOCATION (NO.) (STREET) / t
OF BETWEEN EL_Nt AND 1--6—DERPf 3 1
BUILDING (CROSS STREET) (CROSS STREET)
NOTES
LOT
SUBDIVISION LOT BLOCK SIZE
N
II. TYPE AND COST OF BUILDING - All applicants complete Parts A - D -I
73
A. TYPE OF IMPROVEMENT D. PROPOSED USE - For"Wrecking" most recent use m
M
. -4
1 I I New building Residential Nonresidential
2I I Addition(If residential, enter number 12I I One family 18 I Amusement, recreational
of new housing units added, if any,
in Part D, 13) 13 I I Two or more family - Enter 19 rI Church, other religious
IX. SITE OR PLOT PLAN — For Applicant Use number of units- - - - -� 20 I Industrial
3F-1 Alteration (See 2 above)
= = 14 I I Transient hotel, motel,
4 I Repair, replacement or dormitory - Enter number 21 I Parking garage
•..•.:.■....■.q...= :: .
_ _ . 5 I I Wrecking (I/multifamily residential, of units - . . 22 I Service station, repair garage
enter number of units in building in 151. I Garage 23 I Hospital, institutional
lie Part D, ]3)
16 I I
Carport 24 Office, bank, professional
... _
_ 6 I Moving (relocation) 17I I Other - Specify 25 Public utility
N■• u■■••■■■••• = 7 I Foundation only
26 School, library, other educational
B. OWNERSHIP 27 I Stores, mercantile
: : 28 1 Tanks, towers
r = 8 I 1 Private (individual, corporation,
nonprofit institution, etc.) 29 I Other - Specify
: 9 L-I Public (Federal, State, or
=.s U S local government)
:: _ : : C. COST (Omit cents) Nonresidential - Describe in detail proposed use of buildings, e.g., food
Li: processing plant, machine shop, laundry building at hospital, elementary
: _••: 10. Cost of improvement $ 000 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 u of existing building is being changed, enter proposed use.
_■..■■.•.g = _
_ in the above cost ^r, 1
Cs
::::::::::•onwstrososex■ •.■ .■u.uu..•.•u.. : : ■■ a. Electrical f j,. ✓* -e
.....:::::::: _ : _ �■ b. Plumbing
NI
=::ii::■■: SOON== : __:_•= c. Heating
, air conditioning
•::::::...N:
tint :'::::::::::: _ e•. d. Other (elevator, etc.)
'_••__•••■■•• ••■■•:::::: :::::: _
• �~ .b 11. TOTAL COST OF IMPROVEMENT $. 1, k )0
•`!■■!. : :_:.:____E_ UN: :■.! III. SELECTED CHARACTERISTICS OF BUILDING - For new buildings and additions, complete Parts E - L;
='=S'= == !l::::: _ _•M_ _ _ _ :i :Pa: for wrecking, complete only Part J, for all others skip to IV.
:a:.: Mt p.p..: : _ : p= E. PRINCIPAL TYPE OF FRAME G. TYPE OF SEWAGE DISPOSAL J. DIMENSIONS
: : : 30 I I Masonry (wall bearing) 40 I'. I Public or private company Number of stories
_ : : __ : 31 I I Wood frame 41 I I Private (septic tank, etc.) 49. Total square feet of floor area,
■e =_��_•■• • •• • :eel : = 32 h all floors, based on exterior
�i::: ::•:.e:::■:esee: : : : _ ` I Structural steel dimensions
':i:: ::::: :.. : : in 33I I Reinforced concrete H. TYPE OF WATER SUPPLY
1:�:::::::::::::::: :•s. _.••:':■e:: ::: :e : : : : 34 I I Other - Speci/y 42 [__I Public or private company 50. Total land area, sq. ft.
'•••■ ■_ mi �=_::: ••.u• .1...:::::::: •• •■_ 43 I Private (well, cistern) K. NUMBER OF OFF-STREET
e hi. ee : : • :... : : ::■e PARKING SPACES
f
: ::::i:' ee= ••_ • ■�a • ::$ �'■e.■• .=�!•`=erp=a ::.e':i::: =s;�i:ii:i:: j:ZZ:■�:: : ira _ :1i un 51. Enclosed
:::::::.:..11.ii• Bii WI iiiii �:.:..■:e ni3: e......�•..:ii...::.:::::::.::.'r. : _ : F. PRINCIPAL TYPE OF HEATING FUEL I. TYPE OF MECHANICAL
i i iii _•. eii:i':'es'ii=::. e:::::::ui i '':ae.: :s.:as::::'::: s ': ' :..••■ •... . .. . ...
., •• ��i ': ::5 ::: _ _ � Si_::: : : _ ::'_::•�••:::1•:: :: : 35 it Gas Will there be central air 52. Outdoors
:::: : :: :■•■::•..s :: " H .�: :••.■.:::� :'�::_::i:■N■ • • • :• :::::::::: Y.� ■ .• . i conditioning'
+ 'ii i.: :::: :_ :i:N: • _ ::.�j:: 3: i =�'iii:iii 'e •.i :�•■ • •:: :■■ ■■w•5::.•:■■:_:::•:• i:�' �.5:=:::a Q= I I L. RESIDENTIAL BUILDINGS ONLY
* •: ii3i� ii ii :i iii... .Z•:�•••ii �. :. : :r_��::�:�••es• ■t .fig : �� : 36 Oil
:: ::: :::: : :: '� ::::::::;:�_: : ::: Z::. :Siiiii::=:::::�:::::•:: :i== 'f':i:::••••: ::.■.= 37I-� Electricity —
• •ram a: :u� ■■.u._ . ■■ ■ H•• ��� ae ��•��� 44 i Yes 45 . No 53. Number of bedrooms
li�H��u■�ill ill imi■:in : iisriligis: .i. „fi l ,'ass:•:as a iniik ihiiii:s ? $ s: uussrovi•s:�=c: :nii:..B.�_:::::=:::s = 38 I I Coal
Mill '1_ * :uxu:::u::::::::• 1QZ �iia� a;=5 ::' oliVIM Z INIUMEIge 1:i::a::::::,4.! : 39 I I Other - Specify Will there be an elevator'
Full
54. Number of
46 H1 Yes 47 I I No bathrooms
Partial
P;MT N P
IV. IDENTIFICATION — To be completed by all applicants
Name Mailing address — Number, street, city, and State - ZIP code Tel. No.
} RD* e t C r ;�, NOTES and Data — (For department use)
Owner or _
Lessee
(7eZ
•�'1 Builder's
2. License No.
Contractor re.
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
DO 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 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 rf 3 FOR DEPARTMENT USE ONLY
Permit number
Building- ' D' Use Group
Permit issued 7 19
Building
Fire Grading
Permit Fee $ Live Loading
Certificate of Occupancy $ Occupancy Load
A•• .y:
Drain Tile
Plan Review Fee $
TITLE