17C-009 (3) ZONING •
DISTRICT
L
F-
FRONT YARD
SIDE r r
REAR YARD
NOTES
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NOTES and Data — (For deportment use)
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1
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IDENTIFICATION — To be completed by all applicants
Name Mailing address — Number, street, city, and State ZIP 6-)de Tel. No.
ner or
ssee
Builder's
p {�) I(�l 1 , ✓ License No.
mtroctor
rchitect or
ngineer
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 Date Plans By Notes
Fee Started Approved
BUILDING $
PLUMBING $
MECHANICAL $
ELECTRICAL $
OTHER J Is
V1. ADDITIONAL PERMITS REQUIRED OR OTHER JURISDICTION APPROVALS
rovaI Check Number Permit or Approval Check Date r y pp Ch Date
Permit or A umer
PP Obtained 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 FOR DEPARTMENT USE ONLY
Permit number
Building- Use Group
Permit issued ,Z,::� 19
Building Fire Grading
Permit Fee Live Loading
Certificate of Occupancy $ Occupancy Load
Approved by:
Drain Tile $
Plan Review Fee $
TIT
�p �
CITY OF NORTHAMPTON
9� 4 MASSACHUSETTS
4
OFFICE of the INSPECTOR of BUILDINGS
'"t � Page r,'' _ Plot APPLICATION FOR
INSPECTOR ZONING PERMIT AN
BUILDING PERMIT
IMPORTANT — Applicant to co to all items in se tons: 1, ll, /U, ►V, and IX. C
�7 G
IN
(• AT (LOCATION) ZONING
` ZONIN CT i
LOCATION (RO.) (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 —N+
A. TYPE OF IMPROVEMENT D. PROPOSED USE — For"Wrecking" most recent use M
M
-a
1 New building Re idential 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— — — — --y 20 Industrial
3 Alteration (See 2 above) 14 � Transient hotel, motel,
21 �� Parking garage
4 Repair, replacement or dormitory — h n t e r number
5 ❑ Wrecking (lj 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 Public utility
7 n Foundation only 26 L School, library, other educational
B. OWNERSHIP 27 F]I J Stores, mercantile
tl/(�J Private (individual, corporation, 28 Tanks, towers
nonprofit institution, etc.) 29 n Other — .Specify
9 D 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....................... T
b. Plumbing ....................... J
c. Heating, air conditioning..........
d. Other (elevator, etc.).............
11. TOTAL COST OF IMPROVEMENT $
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 /V.
E. PRINCIPAL TYPE OF FRAME G. TYPE OF SEWAGE DISPOSAL J. DIMENSIONS
30 L�tMasonry (wall bearing) 4 Public or private company
48. Number of stories........
31 Wood frame 1 Private (septic tank, etc.) 49. Total square feet of floor area,
all floors, based o tenor
32 Structural steel dimensions ..... .... t'?r'
33 C� Reinforced concrete H. TY E OF WATER SUPPLY
r
d Total land area, s
34 Other — ,Specify 42, _ Public or private company 50. q' ft. ...........
43 Private (well, cistern) K. NUMBER OF OFF-STREET
PARKING SPACES
51. Enclosed ................./
F. PRINCIPAL TYPE OF HEATING FUEL I. TYPE OF MECHANICAL
35 1 l Gos Will there be central air 52. Outdoors..................
36 � Oil conditioning?
L. RESIDENTIAL BUILDINGS
3 l- Electricity 44 Yes 45 No 53. Number of bedrooms...... —_
38 F Coal )
39 Other — Spc ijy� Will there be an elevator? Full.....
GGGGG 54. Number of
46 Yes 47 No bathrooms
Partial,.�...
rG
.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 has
authorized agent.
t
SIGNATURE OF AGENT h J
ADDRESS
(NUMBER) _(ST,REET) _ ., (CITY)
APPROVED BY TITLE
DATE 19
DEPARTUENT OF BUILDING INSPECTIONS Z DEPT. FILE COPY
212 MA E
NoRTrar*ON, MA, 01060 D a
PERMIT
VALIDATION
17C - 9
DATE Novpmhpr 10. 19 So PERMIT NO. 668
APPLICANT dames Rapinahuk ADDRESS 31 QAk S _Str t. Florence
(NO.) (STREET) (CONTR'S LICENSE)
NUMBER OF
PERMIT TO ll t:arat;i0318 ( 2 _) STORY Mi scan aneous alteration DWELLING UNITS 1
(TI E OF IMPROVEMENT) NO. (PROPOSED USE)
AT (LOCATION) I oak Street Florence ZONING URB
(N0.) (STREET) 0ISTR ICT
m BETWEEN AND
(CROSS STREET) (CROSS STREET)
a LOT
m SUBDIVISION LOT BLOCK SIZE
a
U
0 BUILDING IS TO BE FT. WIDE BY FT. LONG BY FT. IN HEIGHT AND SHALL CONFORM IN CONSTRUCTION
0
O
Z TO TYPE USE GROUP BASEMENT WALLS OR FOUNDATION
g (TYPE)
REMARKS: Green house solar—addition; g"t inside. insulation, wiring, plumbing*
interior & exterior doors, cosmetic changes, existing wood stove.
AREA OR PERMIT
VOLUME (CUBIC/SQUARE FEET) ESTIMATED COST FEE 10- 0
OWNER James Rapischuk BUILD G D 1
ADDRESS BY
(Affidavit on reverse side of application to be completed by authorized agent of owner)