17C-144 (4) Vill. ZONING PLAN EXAMINERS NOTES
DISTRICT
FRONT YARD
SIDE YARD SIDE YARD
REAR YARD
NOTES
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NOTES and Data — (For department use)
IV. IDENTIFICATION — To be completed by all applicants
Name �y Mailing,address
�+-- Number, street, city, and State ZIP code Tell.. No.
1.
Owner or
Lessee /
Builder's
2• !� e l License No.
Contractor
3.
Architect or
Engineer
I reby certify that the proposed work is authorized by the owner of record and that I have been authorized by the owner to
e this application as his authorized agent and we agree to conform to all applicable laws of this jurisdiction.
applicant / Address Application date
7- J7X
of
D0 NOT WRITE BELOW THIS LINE
V. PLAN REVIEW RECORD — For office use
Plans Review Required Check Plan Review Date Plans By Date Plans B Notes
Fee Started Approved y
BUILDING $
PLUMBING $
MECHANICAL $
ELECTRICAL Is
OTHER Is L
V1. ADDITIONAL PERMITS REQUIRED OR OTHER JURISDICTION APPROVALS
Permit or Approval Check Date Number By Permit or Approval Check Date Number B
Obtained Obtained 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 DEPARTMENT USE ONLY
Permit number
Building.
/ p� Use Group
Permit issued l ���"��� � 19
Building i Fire Grading
Permit Fee $ 1
Live Loading
Certificate of Occupancy $ Occupancy Laa
Ap OVed' by:
Drain Tile $
CE�' 1 / t
Plan Review Fee $
TITLE
4 - F
CITY OF NORTHAMPTON
MASSACHUSETTS
$ OFFICE of the INSPECTOR of BUIL INGS
Page 1 , Plot APPLICATION FOR
INSPECTOR ZONING PERMIT AND
BUILDING PERMIT
z
IMPORTANT — Applicant to complete all items in sections: 1, 11, 111, IV, and IX. O
I• AT (LOCATION) / // `-� DIOSTR CT/ �
LOCATION (N0.) (STREET)
OF BETWEEN AND
BUILDING (CROSS STREET) CROSS STREET)
LOT
SUBDIVISION LOT BLOCK SIZE
N
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 Residential Nonresidential
2 Addition(1/ 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— — — — —� 20❑ Industrial
3 F__1 Alteration (See 2 above)
14 ❑ Transient hotel, motel, 21 Parking garage
4❑ Repair, replacement or dormitory — Enter number
5 Wrecking (if multifamily residential, of units ——————— — -i 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 ❑ Foundation only
26 ❑ School, library, other educational
B. OWNERSHIP 27❑ Stores, mercantile
8 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......••••••.... c�:20 0 0 O 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 1$ OG'•Ct�
III. SELECTED CHARACTERISTICS OF BUILDING — For new buildings and additions, complete Parts E — L;
for wrecking, complete only Part J, for aft 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
34 ❑ Other — Specify 42 F-1 Public or private company 50. Total land area, sq. 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 ❑ Gas Will there be central air 52. Outdoors........................
36 ❑ Oil conditioning? L. RESIDENTIAL BUILDINGS ONLY
37 Electricity 44 ❑ Yes 45 ❑I No 53. Number of bedrooms..............
38 ❑ Coal
39 Other — Specify Will there be an elevator? Full..........
_ 54. Number of
46 r � Yes 47 I No bathrooms Partial........
Department of Bj.:;l d:,;g Inspections
212 Main Street
Northampton, Mass. 01060 BUILDING O° Q
PERMIT
17C - 144 ff
VALIDATION
7,,,, DATE August 171 19 84 PERMIT NO. 359
APPLICANT John & Barbara Matteson — ADDRESS Key— Street Home Owners
IN (STREET) (CONTR'S LICENSE)
Wreckin NUMBER OF
PERMIT TO g (—) STORY Garage/At2ChPd ShPd DWELLING UNITS
(TYPE OF IMPROVEMENT) NO. (PROPOSED USE)
ZONING
AT (LOCATION)
40 Keyes Street - - DIISTR CT URB
(NO.) STREET)
BETWEEN AND
(CROSS STREET) (CROSS STREET)
LOT
SUBDIVISION 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)
Permit for the demolition of existing anP Q Q and attached shed.
REMARKS: - LET-.ac�lrc`).ae
AREA OR 200.00 PERMIT 10.00 —
VOLUME ESTIMATED COST FEE
(CUBIC/SQUARE FEET)
OWNER John & Barbara Matteson
ADDRESS eyes Street, Florence, Mass. 01060 By
WHITE - FILE COPY . GREEN - FIELD COPY ■ CANARY - APPLICANT COPY • PINK - ASSESSORS COPY