25C-256 (3) ZONING •
DISTRICT Z2 /
FRONT YARD
SIDE YARD SIDE YARD
REAR YARD
OR PLOT PLAN For Applicant
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NOTES and Data — (For department use)
IV. IDENTIFICATION — To be completed by all applicants
Name Mailing address — Number, stmt, city, and State ZIP code Tel.
Owner or
Lessee
Builder's
2. License No.
Contractor t/
a f
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.
Signaftof 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 Date Plans By Notes
Fee Started Approved
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 SIGN OR BILLBOARD
FURNACE STREET GRADES
GRADING USE OF PUBLIC AREAS
OIL BURNER WRECKING
OTHER OTHER
II. VALIDATION
Building FOR DEPARTMENT USE ONLY
Permit number
Building- Use Group
Permit issuede. ! � 19��
Building Fire Grading
Permit Fee $ Live Loading
Certificate of Occupancy $ Occupancy Load
Approved by:
Drain Tile $
Plan Review Fee $
CITY OF NORTHAMPTON
MASSACHUSETTS
$ e
OFFICE of the INSPECTOR of BUILDINGS
Page Plot APPLICATION FOR
ZONING PERMIT AND
INSPECTOR BUILDING PERMIT
IMPORTANT — Applicant to complete all items in sections: 1, 11, III, IV, and IX. O
�/7 -ice rr ZONING
I• AT (LOCATION) // L-�r�til J / DISTRICT
LOCATION (N6.) (STREET)
OF BETWEEN AND
BUILDING (CROSS STREET) (CROSS STREET)
LOT
SUBDIVISION LOT BLOCK SIZE
V1
II. TYPE AND COST OF BUILDING — All applicants complete Parts A — D —f
A. TYPE OF IMPROVEMENT D. PROPOSED USE — For"Wrecking" most recent use m
M
1 ❑ New building Reside tiol Nonresidential
2 El Addition(If residential, enter number family 18 ❑ Amusement, recreational
of new housing units added, if any,
in Part D, 13) 13 Two or more family - Enter n 19 ❑J Church, other religious
number of units- - - - -� 0j 20 L❑ Industrial
3 Alteration (.See 2 above) 14 ❑ Transient hotel, motel, 21 ❑ Parking garage
4 Repair, replacement or dormitory - Enter number
5 ❑ Wrecking (ll 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 25 Public utility
Other - Specify ❑ Y
7 ❑ Foundation only 26 ❑ School, library, other educational
B. OWNERSHIP ��/'�-� %tom " L'� 27 ❑ Stores, mercantile
❑8� Private (individual, corporation, 28 Tanks, towers
nonprofit institution, etc.) '�L 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•••••••••••••••• ! 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 is
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) Public or private company Number of stories......
31, Wood frame 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 ❑ 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? Full.........
54. Number of
46 ❑ Yes 47 FVN. bathrooms 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 h+s
authorized agent.
SIGNATURE 'OF AGENT
ADDRESS
(NUMBER) (STREET) (CITY)
APPROVED_,BY TITLE
DATE 19
f - -
DEPT. FILE COPY
DEPARTMENT OF BUILDING INSPECTIONS
212 MAIN STREET BUILDING a°
NORTHAMPtON, MA. 01060 PERMIT VALIDATION
25C - 256
DATE Sept,. at 19 80 PERMIT NO. 467
APPLICANT F1 aino YP_Ski R ADDRESS 17 Fair
(NO.) (STREET) (CONTR'S LICENSE)
NUMBER OF
PERMIT TO WAAd RtnyR (-2_) STORY Wood-tlUrnin+� q tave DWELLING UNITS 2
(TYPE OF IMPROVEMENT) NO. (PROPOSED US )
ZONING
AT (LOCATION) 17 Fair DISTRICT TMA
(NO.) (STREET)
a BETWEEN AND
a
(CROSS STREET) (CROSS STREET)
IL LOT
m SUBDIVISION LOT BLOCK SIZE
a
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)
ir
O
LL REMARKS: Wnad st-ove installed in fireplace - separate flue
AREA OR �/ PERMIT $ .
VOLUME ESTIMATED COST $ 7nn F 00 FEE 1n n
(CUBIC/SQUARE FE _.....
OWNER Paul Yeskie
ADDRESS 17 Fair Street. Northampton} Ma. 01060 BUILDING D PT. j2d
(Affidavit on reverse side of application to be completed by authorized agent of owner)