17C-006 (6) VIII. ZONING PLAN EXAMINERS NOTES
DISTRICT
USE
FRONT YARD
SIDE YARD SIDE YARD
REAR YARD
NOTES
IX. SITE OR PLOT PLAN — For Applicant Use
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BOCA FORM APEBP — 669 C1969 BUILDING OFFICIALS & CODE ADMINISTRATORS INTERNATIONAL, INC.
IV. IDENTIFICATION — To be completed by all applicants
Name Mailing address — Number, street, city, and State ZIP code Tel. No.
Owner or
Lessee
Builder's
L.
License No.
Contractor
�.
c �-
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.
Signa)te �,c7,p 1icant /C1Js' ation date
60 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
VII. VALIDATION
Building ��� FOR DEPARTMENT USE ONLY
Permit number
Building n 4 Use Group
a
Permit issued ,._�, 19��
Building Fire Grading
Permit Fee /?11V
Live Loading
Certificate of Occupancy $ Occupancy Load
Approved by:
Drain Tile $
Plan Review Fee $
TITLE
�t
NOTES and Data — (For department use)
1
APPLICATION FOR
PLAN EXAMINATION AND
BUILDING PERMIT
IMPORTANT — Applicant to complete all items in sections: I, 11, III, IV, and IX. O
ZONING
I• AT (LOCATION) 6 DISTRICT
LOCATION (N0:) (STREET)
OF BETWEEN _AND
BUILDING (CROSS STREET) (CROSS STREET)
LOT
SUBDIVISION LOT_ BLOCK SIZE
to
II. TYPE AND COST OF'BUILDING — All applicants complete Parts A — D
A. TYPE OF IMPROVEMENT D. PROPOSED USE — For"Wrecking" most recent use m
M
1 ❑ New building Reside ti al 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— — — — --)0' 20 ❑ Industrial
3 ❑ Alteration (See 2 above) 14 Transient hotel, motel,
❑ 21 ❑ Parking garage
4 ❑ Repair, replacement or dormitory — Enter number
❑ 22 ❑ Service station, repair garage
5 Wrecking (If multifamily residential, of units -------- — -�
enter number of units in building in 15 ❑ Garage 23 Hospital, institutional
Part D, 13) 16 D Carport 24❑ Office, bank, professional
6 ❑ Moving (relocation) p
17�Other — Specify_ 25 ❑ Public utility
7 ❑ Foundation only
Ir 26 ❑ School, library, other educational
B. OWNERSHIP 27 ❑ Stores, mercantile
8 [X 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,,,,,,,,•,••,••• 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 9UILDING — 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) 40 ❑ Public or private company 48• Number of stories................
31 Wood frame 41 ❑ 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 /4f ��
34 ❑ Other — SpeciJy 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 E CiI conditioning? L. RESIDENTIAL BUILDINGS ONLY
37 ❑ Electricity 44 ❑ Yes 45 ® No 53. Number of bedrooms..............
38 ❑ Coal
39 ❑ Other — Specify Will there be on elevator? Full..........
54. Number of
46 ❑ Yes 47 [j� No bathrooms
Partial.......
Department of Building Inspections
212 Main Street
Nq�.thampton, Ma; 01060 BUILDING 0° d ,
17C - 6 PERMIT a a
VALIDATION
DATE imp in, 19 R1 PERMIT NO.__ 282
APPLICANT_ Alhprt WgIctZ ADDRESS- 40 North
(NO.) Hatfield
(NO.) (STREET) (CONTR'S LICENSE)
NUMBER OF
PERMIT TO Adda*;^�} ( ) STORY Sun r�l DWELLING UNITS 1 _
bF`iroiPROVEMENT) NO. (P?w 10, D USE)
AT (LOCATION) 24 Lake ZONING
(N0.) (STREET) DISTRICT UItB
BETWEEN AND
(CROSS STREET) (CROSS STREET)
SUBDIVISION LOT
LOT BLOCK SIZE
Addition
,")M)MIS TO BE 14 FT. WIDE BY 22 FT. LONG BY FT. IN HEIGHT AND SHALL CONFORM IN CONSTRUCTION
TO TYPE USE GROUP BASEMENT WALLS OR FOUNDATION
(TYPE)
REMARKS: Addition of enclosed sunporch - sliding glass door, casement windows, heated
AREA OR ESTIMATED COST �_ 50800 FEE MIT
VOLUME (CUBIC/SQUARE FEET) $- 18-00
i
OWNER Si dnev & june Carl
ADDRESS 24 1.a Street. Florence. Ma_ 01060 BUILDING D T.
WHITE - FILE COPY - GREEN - FIELD COPY ■ CANARY - APPLICANT C - PINK - ASSESSORS COPY
. . � ..� .,T.., ., .. „w,., ,��.��a
Department of Building Inspections
212 Maio. street . BUILDING ~
Northampton, Ma;N�,0106€ o°
17C w 6
PERMIT ,
VALIDATION
DATE time+ 10, 19 81 PERMIT NO. 282
APPLICANT Aj} rt tlnn�eFm r ADDRESS GLfl North Rtra to Hatfield(NO.)). (NO.)> (STREET) (CONTR'S LICENSE)
y,UMBER OF
PERMIT TO 'STORY Sj>:ni�iCl'L'cb DWELLING UNITS
ROVEMENT) NO. (t POM USE)
ZONING
AT (LOCATION) DISTRICT URB
(NO. (STREET) 5�
BETWEEN AND
(CROSS STREET) - (CROSS STREET)
LOT
SUBDIVISION -- LOT--BLQCK SIZE
Addition
9"WS TO BE FT. WIDE BY L NG tN
N EIG AND SHALL CONFORM IN CONSTRUCTION
TO TYPE USE GROUP BASEMENT MALLS R FO b
(TYPE)
REMARKS: Addition of enclosed Aiiwarch - sliding glass door, casement windows, heated
AREA ESTIMATED COST .� FEEMIT
VOLUME E
(CUBIC/SQUARE FEET)
OWNER Sidnay & June Carl
BUIL NG D !T. „eeTT
ADDRESS 24 T.Akp- ,Street, flarenee}„Ma. 01.060 BY
WHITE - FILE COPY . GREEN - FIELD COPY • CANARY APPLICANT C —PINK ASSESSORS COPY
a - -