29-269 (4) ZONING •
DISTRICT
FRONT . ,
SIDE YARD SIDE YARD
REAR YARD
IX. SITE • • PLOT PLAN For Applicant
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NOTES and Data — (For department use)
IV. IDENTIFICATION - To be completed by oil applicants I Nwiftr
Name Mailing address — A'tmber, strcct, (it%, gym,/ Slat" ZIP code Tel. No.
1.
Owner or �L `" v
Lessee
Builder's
License No.
Contractor — — — —
3. �,
Architect or � -
Engineer
I hereby certify that the proposed work is authorized by the owner of record and that 1 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
l c �K� 2&-
DO NOT WRITE BELOW THIS LINE
V. PLAN REVIEW RECORD - For office use
Plans Review Required Check Plan Review Date Plans B Date Plans B Notes
9 Fee Started y Approved y
BUILDING
PLUMBING
MECHANICAL
ELECTRICAL
OTHER Is
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 SIGN OR BILLBOARD
FURNACE STREET GRADES
GRADING USE OF PUBLIC AREAS
OIL BURNER WRECKING
OTHER OTHER
VII. VALIDATION
Building
Permit number
Building
Permit issued (/C{ &y 19
Building t
Permit Fee a_�/Fv-G �
Certificate of Occupancy
Ap ved b .,
Drain Tile S
i
Plan Review Fee S—
TITLE
� � �Isssacllusctfs
�b
City of Xort4aurpton
a t Office of the Ynoptrtor of 'uilbings
APPLICATION FOR
P J�!, = ZONING PERMIT AND
Page �` Plot BUILDING PERMIT
IMPORTANT — Applicant to complete all items in sections: 1, 11, 111, IV, and IX. Z
/ � ✓^ / //-- A I/ ZONING I //
I• AT (LOCATION)` t-JJ hriC^�-•�. 06 ` G-I DISTRICTVVILVVIIL..
LOCATION (NO.) (STREET
OF BETWEEN AND
BUILDING (CROSS STREET) (CROSS STREET)
LOT
SUBDIVISION LOT _BLOCK SIZE
y
II. TYPE AND COST OF BUILDING — All applicants complete Parts A — .D
M
A. TYPE OF IMPROVEMENT D. PROPOSED USE — For"Wrecking" most recent use R1
1 ❑ New building Residential Nonresidential
2 ❑ Addition(If residential, enter number 12!,K One family 18 ❑ Amusement, recreational
of new housing units added, if any, 13 ❑ Two or more family — Enter 19 ❑ Church, other religious
in Part D, 13) units — — — �
J — 20 ❑ Industrial
3 ❑ Alteration (See 2 above) number o
14 ❑ Transient hotel, motel, 21 ❑ parking garage
4 ❑ Repair, replacement or dormitory — Enter number
5 F—] Wrecking (If multifamily residential, of units ——————— — -i 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 1Q Other — Specify ' 25 ❑ Public utility
7 ❑ Foundation only
,a 26 ❑ School, library, other educational
B. OWNERSHIP �V40 PLl 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................ �r - school, secondary school, college, parochial school, parking garage for,
department store, rental office building, office building of industrial plant.
To be ins/ailed 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 I$
III. SELECTED CHARACTERISTICS OF UILDING — For new buildings and additions, complete Parts E — L;
for wrecking, complete only Part J, for all others skip to IV. y
O
E. PRINCIPAL TYPE OF FRAME G. TYPE OF SEWAGE DISPOSAL J. DIMENSIONS m
49• Number of stories...... ..
49 Total square feet ,
30❑ Masonry (wall bearing) 40 ❑ Public or private company
31 Wood frame 41 Private (septic tank, etc.) . floor a arearea,
all floors, based on exterior
32 ❑ Structural steel dimensions .....................
33 ❑ Reinforced concrete H. TYPE OF WATER SUPPLY
34 Other — Specify 42 F-1 Public or private company 50. Total land area, sq. ft. ...........
43 (❑ Private (well, cistern) K. NUMBER OF OFF-STREET
PARKING SPACES
51. Enclosed ....................... r
F. PRINCIPAL TYPE OF HEATING FUEL I. TYPE OF MECHANICAL O
35 ❑ Gas Will there be central air 52. Outdoors........................
36 ❑ Oil conditioning? L. RESIDENTIAL BUILDINGS ONLY
37 Electricity 44 ❑ Yes 45 ❑ No 53. Number of bedrooms..............
38 ❑ Coal
39 Other — Specify Will there be an elevator? 54. Number of Full..........
46 [�] Yes 47 [:] No bathrooms I I
I hereby certify that the ;proposed work is authorized by the owner of record
and I have been authorized by the owner-to _Take this application as his
authorized agent.
SIGNATURE OF AGENT
ADDRESS
(NUMBER) (STREET) (CITY) -
APPROVED BY TITLE
DATE 1g
DEPT. FILE COPY
Z❑
DEPT. OF BUILDING INSPEC710NS BUILDING <a
212 Main Street PERMIT VALIDATION
Northampton, Mass. 01060 29-269
DATE .A.7 )R+ Pty 19 _ PERMIT NO. 352
APPLICANT Gordon R Boggtock ADDRESS 45 TnY1g�T, ,�r Dritr , Flo.
(N0.) (STREET) (CONTR'S LICENSE)
NUMBER OF
PERMIT TO AhovP. grrnmr� :00� (_) STORY Swimming Pool DWELLING UNITS
(TYPE OF IMPROVEMENT) NO. (PROPOSED USE)
ZONING TEA
AT (LOCATION) 4 g
LonyiPw DriVP DISTRICT
(NO.) -'c (STREET)
BETWEEN AND
(CROSS STREET) (CROSS STREET)
LOT
i SUBDIVISION LOT BLOCK SIZE
I
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)
C
� REMARKS:
PERMIT
VOLUME `J4 ESTIMATED COST $ 1200 00 FEE $
AREA OR 10.00
(CUBIC/SQUARE FEET)
s
OWNER Cgorrinn R BO-q+n0k L P
ADDRESS 45 Longview Drive, Florence, Ma.
(Affidavit on reverse side of application to be completed by authorized agent of owner)