35-007 (21) VIII. ZONING PLAN EXAMINERS NOTES
FRONT
SIDE YARD SIDE YARD
REAR YARD
Ix. SITE OR PLOT PLAN For Applicant Use
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NOTES and Data — (For department use)
c /
IV. IDENTIFICATION — To be completed by all applicants
Name Mailing address — Nimbc°r, strcct, citN, uud Staw ZIP code rel. No.
Owner or " _I ✓Y!'' S�tys9j iLC r`
Lessee �C t C L n 0 pZC1
Bui Ider's
L.
License No.
Contractor
C
3.
Architect or
Engineer �J
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
00 NOT WRITE BELOW THIS LINE
V. PLAN REVIEW RECORD — For office use
Plans Review Required Check Plan Review Date Plans By y
Date Plans B Notes
q Fee Started Approved
BUILDING
PLUMBING
MECHANICAL
ELECTRICAL
OTHER S
VI. ADDITIONAL PERMITS REQUIRED OR OTHER JURISDICTION APPROVALS
Date D
Permit or Approval Check Obtained Number By Permit or Approval Check Obttaitned 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 "i !' 19
Building �
Permit Fee $ /(
Certificate of Occupancy
Approved by:
Drain Tile
Plan Review Fee _ ✓'
LE
`e Crxty of Xort4aulvton
� � �1'ila�ssxchllsetfs
(Office of the �Jnsptrtor of 'Puilbings APPLICATION FOR
ZONING PERMIT AND
Page �,ti Plot — BUILDING PERMIT
IMPORTANT — Applicant to complete all�items in sections: 1, 11, 111, IV, and IX. p
ZONING
I• AT (LOCATION)
? rry* Lt,/ �� DISTRICT
A
LOCATION (NO.) (STREET)
OF BETWEEN AND
BUILDING (CROSS STREET) (CROSS STREET)
LOT
SUBDIVISION LOT BLOCK SIZE
CA
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 M
1 ❑ New building Residential Nonresidential
2 Addition(1 residential, enter number
❑ J 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
I �
number of units- - - - -� 20 ❑ Industrial U
3 Alteration (See 2 above)
14 Transient hotel, motel,
21 ❑ Parking garage
4 ❑ Repair, replacement or dormitory - Enter number
5 ❑ 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) ice,24❑ Off bank, professional
6 ❑ Moving (relocation) 16 ❑ Carport --
17 ❑ Other - Specify 25 ❑ Public utility
7 ❑ Foundation only 26 ❑ School, library, other educational
B. OWNERSHIP 27 Stores, mercantile
8�0 Private (individual, corporation, 28 ❑ Tanks, towers
nonprofit institution, etc.) 29,,15<'0ther - Specify(_5N1,C_y
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................ (TCt C-r 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..................... 4
b. Plumbing .....................
c. Heating, air conditioning..........
d. Other (elevator, etc.)............
11. TOTAL COST OF IMPROVEMENT $ Qr,vc?
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. D
O
E. PRINCIPAL TYPE OF FRAME G. TYPE OF SEWAGE DISPOSAL J. DIMENSIONS m
48. Number of stories............... ��--
30❑ Masonry (wall bearing) 40 ❑ Public or private company
31'N Wood frame 41);4 Private (septic tank, etc.) 49. Total square feet of Floor area,
all floors, based�o�,nQ�exterior
32❑ Structural steel dimension?-7/ F-''1 _ Op
33 ❑ Reinforced concrete H. TYPE OF WATER SUPPLY
lic or private company 50. Total land area, sq. fT. ...........
34❑ 42 Pub
Other - Specify p
43 Private (well, cistern) K. NUMBER OF OFF-STREET
PARKING SPACES
51. Enclosed ....................... P'
F. PRINCIPAL TYPE OF HEATING FUEL I. TYPE OF MECHANICAL O
35 ❑ Gas Will there be central air 52. Outdoors........................
36 54 Oil conditioning?
L. RESIDENTIAL BUILDINGS ONLY
3 ❑ Electricity 44 ❑ Yes 4A No 53. Number of bedrooms..............
38 ❑ Cool
39 ❑ Other - Specify Will there be on elevator? 54. Number of Full..........
bathrooms
46 ❑ Yes 47 No Partial........
I hereby certify that the proposed work is authorized by the owner of record
and I have been authorized by the owner to make this application as his
authorized agent.
SIGNATURE OV AGENT
ADDRESS
(NUMBER) (STREET) (CITY),
APPROVED BY TITLE
DATE 19 .
DEPT. PILE COPY
Z
w JCITY OF NORTHd ETON BUILDING
NORTMMPTON, MAW. PERMIT VALIDATION
35-7
DATE November 15, 19 77 PERMIT NO. 550
APPLICANT Frederi ek R, Mai 1loux_ ADDRESS 7 5 Bfest Farm_a Rd., F1e.
(N0.) (STREET) (CONTR'S LICENSE)
PERMIT TO Business Alteration NUMBER OF
� ) STORY Snack Bar DWELLING UNITS
(TYPE OF IMPROVEMENT) NO. (PROPOSED USE)
ZONING
AT (LOCATION) — 15 West Farms Road, Florence —DISTRICT
(NO.) (STREET)
a BETWEEN AND
m (CROSS STREET) (CROSS STREET)
W
a LOT
m SUBDIVISION LOT BLOCK SIZE
U
m BUILDING IS TO BE FT.. WIDE BY FT. LONG BY FT. IN HEIGHT AND SHALL CONFORM IN CONSTRUCTION
O
Z TO TYPE USE GROUP BASEMENT WALLS OR FOUNDATION
� (TYPE)
0 REMARKS: Alter existing business to accom daU small snack bar
AREA OR PERMIT
VOLUME ESTIMATED COST $ 0 0() FEE $ I-0.00(CUBIC/SQUARE FEET) �
OWNER fted. R• & c8=14 X811-1.01X
BUILD G T.
ADDRESS 1,5 ](apt Farms R.. Florence, H"S. BY
(Affidavit on reverse side of application to be completed by authorized agent of owner)