29-434 (5) Y111. ZONING PLAN EXAMINERS NOTES
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NOTES and Data — (For department use)
IV. IDENTIFICATION — To be completed by all applicants WIW40
Name Mailing address — Number, strut, city, and State ZIP code Tel. No.
Owner or
Lessee
Builder's /
2. �i O / . �JC! j/ i �, SS !9/0(sU License No.
Contractor
X10 ��Gr
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.
Signs e o pp c t Address Application date
00 NOT WRITE BtL0W THIS LINE
V. PLAN REVIEW RECORD — For office use
Plans Review Required Check Plan Review Date Plans B Date Plans B Notes
q Fee Started y Approved y
BUILDING $
PLUMBING $
MECHANICAL $
ELECTRICAL $
OTHER $
VI. ADDITIONAL PERMITS REQUIRED OR OTHER JURISDICTION APPROVALS
Date 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 I 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• 41j, Use Group
Permit issued 19�
Building Fire Grading
Permit Fee $ Live Loading
Certificate of Occupancy $ Occupancy Load
Approved by:
Drain Tile $
Plan Review Fee $ tP
TI
CITY OF NORTHAMPTON
MASSACHUSETTS
OFFICE of the INSPECTOR of BUI DINGS
3
�uT Page Plot APPLICATION F OR
INSPECTOR ZONING PERMIT AND
BUILDING PERMIT
IMPORTANT — Applic t to complete all items in sec ions: 1, 11, 111, IV, and IX. ` O
ZONING ////�// [r
I• AT (LOCATION) DISTRICT-•A
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 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 19 Church, other religious
number of units- - - - -> 20 Industrial
3 � Alteration (.See 2 above) 14 � Transient hotel, motel,
21 Parking garage
4 Repair, replacement or dormitory - Enter number
5 ❑ Wrecking (11 multifamily residential, of units --- ---- - 22 ❑ Service station, repair garage
enter number of units in building in 15 Garage 23 Hospital, institutional
Part D, 13)
16 Carport 24 Office, bank, professional
6 Moving (relocation)
17 Other - Specify 25 E] Public utility
7 Foundation only
26 School, library, other educational
B. OWNERSHIP al_ 27 Stores, mercantile
8 Private (individual, corporation, Cj 28 Tanks, towers
nonprofit institution, etc.) X l z 29 F:] Other - Specify
9 Public (Federal, State, or
local government)
C. COST (Omit cents) Nonresidential - Describe in detail proposed use of buildings, e.g., food
10. Cost of improvement,,,,,,,,,,,,,,,, processing plant, machine shop, laundry building at hospital, elementary
� 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 $ 0 0 —
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
F. PRINCIPAL TYPE OF HEATING FUEL I. TYPE OF MECHANICAL 51. Enclosed .......................
35 Gas Will there be central air 52. Outdoors........................
36 n Oil condi 'oning?
_ L. RESIDENTIAL BUILDINGS ONLY ,3
37 Electricity 44 D Yes �I No 53. Number of bedrooms..............
Coal
39 Other - Spcci/y Will there be n elevator" Full.
......
_ 54. Number of
46 Yes 47 No bathrooms Partial.,......
Department of Building Inspections
212 Mai treet :n Ma. 01060 BUILDING z
° A Id 0,/)Nor o 0a PERMIT 29-434
VALIDATION
DATE Noyember 4, 1982 PERMIT NO. 628
APPLICANT ,john 1)74,sbak ADDRESS P.0. Box 13. Florence 008764
(NO.) (STREET) (CONTR'S LICENSE)
NUMBER OF
PERMIT TO lUsa� _ l,(lg^( 1-1 STORY At]X313A2N Bldg. DWELLING UNITS 1
(TYPE 0 IMPRO MENT) NO. (PROPOS . USE)
Ellin ten Road ZONING cr URA
AT (LOCATION) �7 8
(NO.) (STREET)
BETWEEN AND
(CROSS STREET) (CROSS STREET)
LOT
SUBDIVISION LOT —BLOCK- -- SIZE
BUILDING IS TO BE FT. WIDE BY 1 2 FT. LONG BY FT. IN HEIGHT AND SHALL CONFORM IN CONSTRUCTION
TO TYPE USE GROUP BASEMENT WALLS OR FOUNDATION
(TYPE)
REMARKS: AUX. BIAS.
AREA OR ESTIMATED COST $ 300-00 FEEMIT $ ,,Q-00
VOLUME
(CUBIC/SQUARE FEET)
OWNER _,John n-4ubsk d
BUILDI PT.
ADDRESS 77 F1.1 fuston RA F1 orence,-Ma. 01060 BY
WHITE - FILE COPY . GREEN - FIELD COPY • CANARY - APPLICANT C INK - ASSESSORS COPY