17A-091 (5) 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 01969 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
.r
LesseeC�
a
Builder's
2. _
License No.
Contractor
3. 17 1I fA1 �
Ij IJ
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.
/
t aSignature of applZ Address Application te
-4
x
`"✓'�-t; _� "l�'/f• F_,. .rte-... /t � .ri,/% _� ._J.
00 NOT WRITE BELOW THIS LINE
V. PLAN REVIEW RECORD — For office use
Plans Review Required Check Plan Review Date Plans B Date Plan
y s
Fee Started Approved By Notes
BUILDING
PLUMBING $
MECHANICAL $
ELECTRICAL
OTHER
VI. ADDITIONAL PERMITS REQUIRED OR OTHER JURISDICTION APPROVALS
Permit or A rova I Check Date Number B Permit or Approval I Check Date Number B
PP Obtained y PP 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 FOR DEPARTMENT USE ONLY
Permit number Q
Building Use Group
Permit issued cs 197—"—
Building Fire Grading
Permit Fee $�_ � Live Loading
Occupancy Load
Certificate of Occupancy
APPr f )by � t
Drain Tile
r
Plan Review Fee
TITLE
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NOTES and Data — (For department use)
CITY OF NORTHAMPTON
OFFICE OF THE INSPECTOR OF BUILDINGS
212 MAIN STREET j� _ APPLICATION FOR
NORTHAMPTON, MA. 01060 / PLAN EXAMINATION AND
BUILDING PERMIT
z
IMPORTANT — Applicant to complete all items in sections: I, 11, 111, IV, and IX. O
ZONING
I• AT (LOCATION) ��"ti` �l' {� I' �� f�' k� DISTRIC
LOCATION (NO') (STREET)
OF y ^
BETWEEN �i t( JI' �._>' 1'I�: ti.i 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
1 ❑ New building Residential Nonresidential
2 ❑ Addition(It 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— — — — --)P- 20 ❑ Industrial
3 Alteration (See 2 above) 14 Transient hotel, motel,
❑ 21 ❑ Parking garage
4 ❑ Repair, replacement or dormitory — Enter number
5 F-1 Wrecking (If 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) 25 ❑ Public utility
17❑ Other — Specify
7 ❑ Foundation only 26 ❑ School, library, other educational
B. OWNERSHIP _ _ 27 ❑ Stores, mercantile
8 ❑ Private individual, corporation, /k 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 $ / l�,"-1,
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
48. Number of stories................
30❑Masonry (wall bearing) 40 ❑ Public or private company
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
42 Public or private company 50. Total land area, sq. fT. ...........
34❑ Other — SpeciJy ❑ p
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 ❑ No 53. Number of bedrooms..............
38 ❑ Coal
39❑ Other — Specify Will there be an elevator? 54. Number of Full..........
46 ❑ Yes 47 ❑ No 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 his
authorized agent.
SIGNATURE F OF AGENT
ADDRESS
(NUMBER) (STREET) (CITY)
APPROVED By TITLE _
DATE 14
Zo
DEPT. FILE COPY
n-
CITY OF NORTHAMPTON BUILDING a
" •��'� VALIDATION
NORTHAMP'T'ON, MA. 01060 17A-91 ■ E
DATE Mny?5, 1978- PERMIT NO 188
APPLICANT &s. Roy Cooke ADDRESS 20 Grandview Street, Flo.
(NO.) (STREET) (CONTR'S LICENSE)
NUMBER OF 1
PERMIT TO Screen in patio (`) STORY Patio DWELLING UNITS
(TYPE OF IMPROVEMENT) NO. (PROPOSED USE)
ZONING
A
AT (LOCATION) 20 Grandview Street DISTRICT
(NO.) (STREET)
rn BETWEEN Mountain Street AND Claire Ave
a
(CROSS STREET) (CROSS STREET)
LOT
a SUBDIVISION LOT BLOCK SIZE
m
0 BUILDING IS TO BE__J'2_ _—�FT. WIDE BY 16 FT. LONG BY FT. IN HEIGHT AND SHALL CONFORM IN CONSTRUCTION
O
m
Z TO TYPE USE GROUP BASEMENT WALLS OR FOUNDATION
(TYPE)
0 REMARKS: Screen in existing Oven -patio
AREA VOLUME ES71MATED COST � 1400.00 FEEMIT 10.00
(CUBIC/SQUARE FEET)
OWNER Rnx conkP
BUI i
ADDRESS 20 Grandview Street, Florence BY
(Affidavit on reverse side of application to be completed by authorized agent of owner)