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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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BOCA FORM APEBP — 669 C1969 BUILDING OFFICIALS & CODE ADMINISTRATORS INTERNATIONAL, INC.
IV. IDENTIFICATION — To be completed by all applicants
Name Mailing address — Number, street, city, and State ZIP code Tel. No.
Owner or 'J�`'�+�-ciyL, �^- �.?L" y r✓' ''°'!"'s.�,�[� '' .`
Lessee
`2. License Builder's
No.
Contractor ..��� E.4
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.
Signatur f applicant +,Ser"4.
Address Application date
Y—
DO NOT WRITE BELOW THIS LINE
V. PLAN REVIEW RECORD — For office use
Plans Review Re uired Check Plan Review Date Plans B Date Plans B Notes
9 Fee Started y Approved y
BUILDING
PLUMBING
MECHANICAL
ELECTRICAL
OTHER
VI. ADDITIONAL PERMITS REQUIRED OR OTHER JURISDICTION APPROVALS
Dae Date
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 /6
Building Use Group
Permit issued 19 _
Fire Grading
Building
Permit Fee $ </ F L 'C1 Live Loading
Certificate of Occupancy Occupancy Load
Approved by:
Drain Tile
Plan Review Fee
TITLE
( H
NOTES and Data — (For department use)
cc..0 Lrc�Q tiwrJ
CITY OF NORTHAMPTON
MASSACHUSETTS
OFFICE OF THE INSPECTOR OF BUILDINGS
APPLICATION FOR
/4 k �,7 �_ PLAN EXAMINATION AND
/ BUILDING PERMIT
IMPORTANT — Applicant to complete all items in sections: 1, II, Ill, IV, and IX. O ZONING
I• AT (LOCATION) Cr ,G f L � �"L•• DISTRICT •
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 I New building Residential Nonresidential
2 k Addition(If residential, enter number 12 X 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 I I Church, other religious
number of units– – – – 20 I Industrial
3 I Alteration (See 2 above)
14 Transient hotel, motel, 21 I I Parking garage
4 I I Repair, replacement or dormitory – Enter number
5 I I Wrecking (If multifamily residential, of units – 22 1 I Service station, repair garage
enter number of units in building in 15 I I Garage 23 Hospital, institutional
Part D, 13)
I 16 ( Carport 24 I Office, bank, professional
6 I Moving (relocation)
17 I Other – Specify 25 Public utility
7I I Foundation only
26 I School, library, other educational
B. OWNERSHIP 27 Stores, mercantile
8 Private (individual, corporation, 28 I Tanks, towers
X
nonprofit institution, etc.) 29 I Other – Specify
9 I I 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 $ G'S e 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 $ (.+ SZ —
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
48.
30 TJ Masonry(wall bearing) 40 I I Public or private company Number of stories
31 r,<1 Wood frame 41 I I Private (septic tank, etc.) 49. Total square feet of floor area,
all floors, based on exterior a�
32 Li Structural steel dimensions //�
33 I Reinforced concrete H. TYPE OF WATER SUPPLY
34 I I Other – Specify 42 Public or private company 50. Total land area, sq. ft.
43 I Private (well, cistern) K. NUMBER OF OFF-STREET
PARKING SPACES
51. Enclosed
F. PRINCIPAL TYPE OF HEATING FUEL I. TYPE OF MECHANICAL
35 I I Gas Will there be central air 52. Outdoors
36I 1 Oil conditioning?
L. RESIDENTIAL BUILDINGS ONLY
37 I I Electricity 44 I I Yes 45 I 1 No 53. Number of bedrooms
381 1 Coal
39I I Other – Specify Will there be an elevator? Full
54. Number of
46 I I Yes 47 I I No bathrooms
Partial
CITY OF NORTHAMPTON Zo
DEPT. FILE COPY
NORTHAMPTON, MA. 01060 BUILDING Q a
37-15 PERMIT VALIDATION
DATE May 10, 19 78 PERMIT NO. 166
APPLICANT Richard R. Gurski ADDRESS 669 Florence RR•
(NO.) (STREET) (CONTR'S LICENSE)
NUMBER OF
PERMIT TO Addition — Residence ( ) STORY DWELLING UNITS 1
(TYPE OF IMPROVEMENT) NO. (PROPOSED USE)
ZONING
AT (LOCATION) 669 Florence Rd. DISTRICT SR
. (NO.) (STREET)
rn BETWEEN AND
0 (CROSS STREET) (CROSS STREET)
01
a LOT
m SUBDIVISION LOT BLOCK SIZE
a
O O BUILDING IS TO BE 12 FT. WIDE BY 1 FT. LONG BY FT. IN HEIGHT AND SHALL CONFORM IN CONSTRUCTION
m
O
Z TO TYPE USE GROUP BASEMENT WALLS OR FOUNDATION
E
(TYPE)
Er- REMARKS: Addition to one—family residence
AREA OR
VOLUME 192 ESTIMATED COST .650.00 FEEMIT 10.00
(CUBIC/SQUARE FEET)
OWNER Richard R. Gurski B �E>�, DEPT (,/'j{) '',�
ADDRESS 669 Florence Rd., Northampton, Ma.. B ,.1.176:1‹./ 0 ^........
(Affidavit on reverse side of a;p rcat on to be. ccrnp!eted by authorized agerFof owner)
--' .... .' CERTIFICATE ISSUED
DATE
=mamma ma. olo67
BUILDING PERMIT, -
CERTIFICATE OF OCCUPANCY
�b
im
DATE 1O1 19 ' PERMIT NO 166
APPLICANT I. Ourad ADDRESS 669 Ploran6a RR.
9f (NO.) (STREET) i. (CONTR'S LICENSE)
PERMIT TO r H ea (_) STORY NUMBER OF
DWELLING UNITS 1
(TYPE OF IMPROVEMENT) Id. (PROPOSED USE)
669
AT (LOCATION) Flornce Ed. ZONING
(N0.) (STREET) - DISTRICT RR
m BETWEEN AND
ID
- -- (CROSS STREET) (CROSS STREET)
m SUBDIVISION LOT BLOCK SIIZE
O BUILDING (S TO BE 12
O FT. WIDE BY 16 FT. LONG BY FT. IN HEIGHT AND SHALL CONFORM IN CONSTRUCTION
m
Z TO TYPE USE GROUP BASEMENT WALLS OR FOUNDATION
E
(TYPE)
IL REMARKS: _ Addition to one-family one-family residence
Kfi C-1 ,"f YI 111 1111,' it l Msi O�6i .,Ef*El 6i 7 *II
AREA OR 1 1p:1I11117T .IIII ynt .1117 'Jn :11S1i :11111 �f cT :I1I1 •IUI, nIUh •III nil
VOLUME . 1 1r1 ri ' It ' m'-',.4,4--1 '`l 'yet. r1 r1 ry I 4Z 7 T 7t '.�
(CUBIC/SQUARE FEET) T
:1111 M :1111 :Ills :1111 NM 1111 ]Ilil NM AM YIII NM NM nm :1111 :1111
Richard R. Gurski WT.II Erin 7b T71 r•rR1 A'T'II RY'cf1•T7 OTTfl brLtl Ertl arT'1I RiRT10' . IA�LTI e-micrt71 C�
OWNER iii �y� /0 y TO BE STED pN PREMISES /
,4. ADDRESS `69 a R d• Northampton. S E -i�r �E
* d ,� fCFONDITI NS OF gRTI�i TE