17C-016 (5) -Vill.—ZONING PLAN EXAMINERS NOTES
DISTRICT
REAR YARD
IX. SITE OR PLOT PLAN For Applicant Use
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NOTES and Data — (For department use)
IV, IDENTIFICATION — To be completed by all applicants
Name Mailing address — Number, street, city, anui .Slab ZIP code Tel. No.
owner or
Lessee
r
Builder'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 Address Application date
00 NOT WRITE BELOW THIS LINE
V. PLAN REVIEW RECORD — For office use
Plan Review Date Plans Date Plans
Plans Review Required Check Fee Started BY Approved BY Notes
BUILDING $
PLUMBING $
MECHANICAL $
ELECTRICAL $
OTHER $
VI. ADDITIONAL PERMITS REQUIRED OR OTHER JURISDICTION APPROVALS
Permit or Approval Check Obtained Number By Permit or Approval Check Obtai ed 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 f!
Building. Use Group
Permit issued ,�( � 19�
Building Fire Grading
Permit Fee $ LV U� Live Loading
Certificate of Occupancy $ Occupancy Load
Approv
Drain Tile $ ti
Plan Review Fee $
TITLE
CITY OF NORTHAMPTON
�e �:* '� MASSACHUSETTS
$ OFFICE of the INSPECTOR of BUILDINGS
�. Page 17C- Plot «° APPLICATION FOR
INSPECTOR ZONING PERMIT AND
BUILDING PERMIT
IMPORTANT — Applicant to complete all items in sections: 1, 11, 111, IV, and IX. n O
I .( [
AT (LOCATION) ZONING
DISTRICT
LOCATION (NO.) STREET)
OF BETWEEN AND
BUILDING (CROSS STREET) (CROSS STREET)
LOT
SUBDIVISION LOT BLOCK SIZE
11. 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 Residential Nonresidential
2 ❑ Addition(It residential, enter number 12 18 ❑ Amusement, recreational
of new housing units added, if any,
in Part D, 13) 13 19 Two or more family - Enter 19 ❑ Church, other religious
number of units- - - - -.> 20 Industrial
3 Alteration (See 2 above) 14 ❑ Transient hotel, motel, ❑
4 ❑ Repair, replacement ❑
❑ or dormitory - Enter number 21 Parking garage
o
5 Wrecking rIl multifamily residential, J units -_----- - --)� 22 E] Service station, repair garage
enter number of units in building in 15 ❑ Garage 23 ❑ Hospital, institutional
Past D, 13)
16 ❑ Carport 24❑ Office, bank, professional
6 ❑ Moving (relocation)
17 ❑ Other - Specify 25 ❑ Public utility
7 ❑ Foundation only 26 ❑ School, library, other educational
r
B. OWNERSHIP 2144=44y 27 ❑ Stores, mercantile
8 Private (individual, corporation, /J_ .
28 ❑ Tanks, towers
nonprofit institution, etc.) �f 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,,,,,,,,,,,,,,,, S.2.sz C — 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 a.�SZto
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 n ``
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
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 7 No 53. Number of bedrooms..............
38 ❑ Cool
39 ❑ Other - Specify Will there be an elevator?
Full..........
�1 U 54. Number of
46 ❑ Yes 47 No bathrooms
Partial........
DEPT. Of BUILDING INSPECTIONS BUILDING ZD I /� 66
212 Main Street 04
Northampton, MA 01060 PERMIT a d
17C - 16 VALIDATION
DATE March 27, 1 86 pE�(+�� IT N,Q, 110
APPLICANT Lawrence Hafey ADDRESS l�fort�ple J ., t'lo. Owner
(NO.) (STREET) (CONTR'S LICENSE)
Addition (_) STORY Existing 2 Family NUMBER OF
PERMIT TO DWELLING UNITS
(TYPE OF IMPROVEMENT) NO. (PROPOSED USE)
AT (LOCATION) 110 North Maple Street, Florence ZONING CT URFS
(N0.) (STREET)
BETWEEN AND
(CROSS STREET) (CROSS STREET)
SUBDIVISION LOT
LOT BLOCK SIZE
BUILDING IS TO BE FT. WIDE BY FT. LONG BY FT. IN HEIGHT AND SHALL CONFORM IN CONSTRUCTION
TO TYPE USE GROUP BASEMENT WALLS OR FOUNDATION
(TYPE)
REMARKS: permit for addition to existing den
AREA OR
VOLUME $ 2 500.00 PERMIT $ 10.00
ESTIMATED COST
(CUBIC/SQUARE FEET) FEE
OWNER Same as Applicant
ADDRESS Same as Applicant s BYILD
WHITE - FILE COPY . GREEN - FIELD COPY CANARY - APPLICANT COPY PINK - ASSESSORS COPY Pixr' ItP