18C-031 (12) e+o� To,, y y
a, `�, � ,� C�iitg of 'ortI amptnn
t .1 ��j /,!,I a jilassad)usetts
ausi! o Office of the ,3lnsprrtor of Alttilbings
.L 7 APPLICATION FOR
/0 �.. Plot 3 ZONING PERMIT AND
Page BUILDING PERMIT
IMPORTANT — Applicant to complete all items in sections: I, II, III, IV, and IX. Z
_ e -_— ZONING S//
I. AT (LOCATION) ir� +4 DISTRICT I�
LOCATION n,C.) S-'7EET7
OF BETWEEN AND
BUILDING )CROSS STREET) (CROSS STREET)
LOT
SUBDIVISION LOT BLOCK - SIZE
t)
II. TYPE AND COST OF BUILDING — All applicants complete Parts A — D xi
m
A. TYPE OF IMPROVEMENT D. PROPOSED USE — For"Wrecking" most recent use m
-i
1 I _ ] New building Residential Nonresidential
2 x.Addition(11 residential, enter number 12 k One family 18 I I Amusement, recreational
of new housing units added, if any,
in Part D. 13) 13 I 1 Two or more family — Enter 19 I I Church, other religious
number of units— — — — —I► 20[ I Industrial
3 I Alteration (See 2 above)
14 I I Transient hotel, motel, 21 I I Parking garage
4 I Repair, replacement or dormitory — Enter number
5 71 Wrecking (If multifamily residential, of units — i 22 ri Service station, repair garage
enter number of units in building in 15 Garage 23 ri H• ospital, institutional
Part D, 13)
16 Carport 24I7 O• ffice, bank, professional
6 [—.1 Moving (relocation)
7 L Foundation only 17I] Other — Specify 25I-I Public utility
26 n S• chool, library, other educational
B. OWNERSHIP CiZe04044.0 jot4V0414.) 27I I Stores, mercantile
8 ul Private (individual, corporation, 28 I Tanks, towers
nonprofit institution, etc.) 29 I-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 $ 4O G — school, secondary school, college, parochial school, parking garage for,
department store, rental office building, office building at industrial plant.
To be irs#alled 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 $ yoo
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
C)
E. PRINCIPAL TYPE OF FRAME G. TYPE OF SEWAGE DISPOSAL J. DIMENSIONS m
m
48.
30[11 Masonry (wall bearing) 40 Public or private company Number of stories
31 5‘6Wood frame 41 ,Private (septic tank, etc.) 49. Total square feet of floor area,
all floors, based on exterior
32 I I Structural steel dimensions
33I I Reinforced concrete H. TYPE OF WATER SUPPLY
34 I7 Other — Specify 42 V Public or private company 50• Total land ores, sq. ft.
43 n Private (well, cistern) K. NUMBER OF OFF-STREET
PARKING SPACES
13
51. Enclosed r-
F. PRINCIPAL TYPE OF HEATING FUEL I. TYPE OF MECHANICAL 0
35 L_] Gas Will there be central air 52. Outdoors —I
36 IX Oil conditioning? L. RESIDENTIAL BUILDINGS ONLY
37 pi Electricity 44 [ -I Yes 45 I I No 53. Number of bedrooms
38I Coal
39 I I Other — Specify Will there be an elevator? 1 Full
54. Number of
46 1 Yes 47 No bathrooms
Partial
IV. IDENTIFICATION — To be completed by all applicants
Name Moiling address - Number, .cfreet, r'it), am! rta ( ZIP code Tel. No.
net or j!
Lessee i,�'t�E-44 I-' I y
Bui Ider's
2. License No.
Contractor
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 d.Address Application date
6-17-77
"r"1-jCe-/e/e...e--i iode.C.41--/‘
DO WIVRITE BELOW THIS LINE
V. PLAN REVIEW RECORD — For office use
Plans Review Re uired Check Plan Review Date Plans B Dote Plans B Notes
9 Fee Started y Approved y
BUILDING
PLUMBING
MECHANICAL
ELECTRICAL $
OTHER S
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 2114
Building
Permit issued June 17. 19 77
Building
Permit Fee $ 10.00
Certificate of Occupancy S
App y:
Drain Tile S
Plan Review Fee S—
LOCAL INSPECTOR
TITLE
•
NOTES and Data — (For deportment use)
l / Al
C
c, o X c S
VIII. ZONING PLAN EXAMINERS NOTES
DISTRICT fixia
USE -64tuAJLUI
PROHT YARD f 2,4/b
SIDE YARD apppwl, /f 4-4 (hi,I SIDE YARD
REAR YARD 171-+
b
NOTES J, Y....04//0440 .04)
446077.400440.7.... "'
xo AL414. ____________
v. 4....
IX. SITE OR I'LOT PLAN — For Applicant Use
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DEPT. FILE COPY
Zs
BUILDING1.
CITY OF NORTHAMPTON PERMIT VALIDATION
DATE Jiule 17, 19 77 PERMIT NO. 2144
APPLICANT Clarence J. Bushey, Jr. ADDRESS t6 Cooke Avenue
(NO.) (STREET) (CONTR'S LICENSE)
NUMBER OF
PERMIT TO Attach S ]J" +A epa7'Aprp ) STORY storage DWELLING UNITS 1
(TYPE OF IMPROV MENT) ` O. (P OPOSED USE)
ZONING
AT (LOCATION) 16 Cooke Avenue DISTRICT SR
(NO.) (STREET)
a BETWEEN AND
'a (CROSS STREET) (CROSS STREET)
a
LOT
a SUBDIVISION LOT BLOCK SIZE
m
4
U O BUILDING IS TO BE FT. WIDE BY FT. LONG BY FT. IN HEIGHT AND SHALL CONFORM IN CONSTRUCTION
m
O
Z TO TYPE __USE GROUP BASEMENT WALLS OR FOUNDATION
f (TYPE)
Cr
0
REMARKS: Attach .atnragP to garage
AREA OR $ 400.00 PERMIT 10_00
VOLUME ESTIMATED COST FEE
(CUBIC/SQUARE FEET) ��//
OWNER Clarence Bushey, Jr- BUILD) //�� a�.��kr+SJ"^'
ADDRESS 16 Cooke Avenue, Northampton BY G-i '�
(Affidavit on reverse side of application to be completed by authorized agent of owner)
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 OF AGENT
ADDRESS
(NUMBER) (STREET) (CITY)
APPROVED BY TITLE
DATE 19 .