05-044 �sl _
INSPECT OR 212 Main Street s Municipal Building
,Vorthonipton, Mass. 01060
Cr'RTIFICATE OF OCCUPANCY
Page No. 5______-21ot
Building (?ta_r e�_ -_-- ��_ � AddrP_Audu- n Roasi, Leeds
Owner Taber . ;krn _ki Address ((
Applicant game Address
Use: 1st aingle familOccupancy Residencge_.____�_v
2nd —v_—__—Occupancy
3rd __ _ —.__...__.___.—O c c upa.n c y _--
4th Occupancy _ _ __.__. __._..__.._.
Zone District t,
Required Inspections:
New Building X� Existing Building _y V
i
Elevator r 7.e;t-r1
Pl umbin Fire'
uuildin Other
T,nspec tor of '.3u:ldings
16-
ZONING PERMIT —T,- 11-p Yo. Loth`
Pile
ile
Zoning APPLICATION
,, ing Ordinziiicc Fl.nji
"Wner Apj)lic, tit 7
Iddress (F]r e S itr-T -ro Al
relephone ✓ Teloplinnc 6%;;
This section is to be filled out in lccordance -,-Jt1i Llic 11T!,ble of DiwmsionJ and
Density Regulationc:. (Z. ).. Al,'TlCLI,'*'
,oning tree Lot Front Depth 'S'U t b,.I c!:'3 —Ii,ax.Bld. I-Tin. Op.
District Area '!"idt)) Front Side jjc_� _ Cover. Space
ast Existing- 3+A MY' 7/.)' X(g %
resent lPropoced
dark the appropriate box to indicate the use of the parcel:
O von-colif,rming Lot ,nd/oi, "trUCturc. Swccify
Residential F�rfily Vilit =Vulti-Fmmily
Duplex Q 0 tbel
Business
Industrial
Institutior-I
Subdivision Q Re,,.,u I -r Q P.1j.D.
Subdivisiol) wi-th
Planning Tloord Approval:
= Zoning Board Approval (,Special Permit 10.(): V'.ri"Ince)
= City Council (Special Exception S. 10.101
Watershed Protection District 0verlj'-y: (Z.O. Sect. -'1V) Yes ITO
Parkins; Space Requiremento: (Z.(,. ,sect. Required Proposed
Loading Space Requirement,c: (Z.0. rect. 8.2) Require:-c1 Froj:;oced
Sims: (7,.0. Art. VII)-
Ye- ITO
Xnvironmental Performance 5tandards: ( Z.O. Art, XJ.I) =yes Orro
.
Plot Plan Yes ro Site Plan Q yez;
(S. 10,.2) , ( 10.2 and 10.11
V,Iniver Grante(3:—Drite
This scction for OFFICIAL uce only:
This'` as preseiitcd:
=1-lodificatiolio, neccv,s.Dry for
Re.turn: (flore infornintion neected)
Denial: Reasons:
Signature of Applicant -Date 'c')i'-'11-t11rc of A(Imill. Officer Dote
ZONING •
SIDE YARD SIDE YARD
IX. SITE OR PLOT
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NOTES and Data — (For department use)
IV. IDENTIFICATION — To be completed by all applicants
Name Mailing address — .A'cumber, strcct, c rtN, �tafc ZIP code Te?. No.
Owner or J\d `l� 7lf 1. �KJ V �_J5 �T��!• r�'Y�`S 1 -6 4
Lessee ✓ 0/0 �
2. i`F3ullder's
'I icense 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 a plicant 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
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 t
Permit number
Building t
Permit issued 19 '7 7
Building
Permit Fee $
Certificate of Occupancy S
Appr ed by:
Drain Tile ,
Plan Review Fee _ /
TITLE
} C�ix#fir Of Nart4amptan
$ � �i i[ass�tcllusetfs
� t
T Of£ire of the �n8}t£Ctvr of 'P>uilbings APPLICATION FOR
✓ Plot ZONING PERMIT AND
Page 4 BUILDING PERMIT
z
IMPORTANT —,Jpplicant to complete all items in sections: I, II, III, IV, and IX. O
�p J, C ZONING
DISTRICT(f j::, �] L7 M � T-
I• AT (LOCATION)
LOCATION (NO') (STREET)
OF BETWEEN AND
BUILDING (CROSS STREET) (CROSS STREET)
LOT
SUBDIVISION LOT__4V_BLOCK SIZE Cn
Ill. TYPE AND COST OF BUILDING — All applicants complete Parts A — D m
A. TYPE OF IMPROVEMENT D. PROPOSED USE — For"Wrecking" most recent use Rt
1 Q New building Residen 'al Nonresidential
2 ❑ Addition(if residential, enter number 72 U �'^e family 18 ❑ Amusement, recreational Q
of new housing units added, if any,
in Part D, 13) 13 ❑ Two or more family — Enter 19 ❑ Church, other religious
number of units— — — — —J� 20 ❑ Industrial
3 ❑ Alteration (See 2 above) 14 Transient hotel, motel,
❑ 21 ❑ Parking garage
4 ❑ Repair, replacement or dormitory — Enter number
5 ❑ Wrecking (I/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 — SpeciJy 25 ❑ Public utility
7 ❑ Foundation only 26 ❑ School, library, other educational
B. OWNERSHIP 27 ❑ Stores, mercantile
28 ❑ Tanks, towers
8 IKPrivate (individual, corporation,
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„..,,•....
�p school, secondary school, college, parochial school, parking garage for,
"' 00o 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
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. y
!7
E. PRINCIPAL TYPE OF FRAME G. TYPE OF SEWAGE DISPOSAL J. DIMENSIONS m
48. Number of stories...............
30❑ asonry (wall beoring) 40 ❑ Public or private company
se 49. Total square feet of floor area,
31 41 Private tic tank, etc.Wood frame u ( p ) all floors, based on exterior
32 ❑ Structural steel dimensions ..................... Q 0y
33 ❑ Reinforced concrete H. TYPE OF WATER SUPPLY 50. Total land area, sq. ft. ........... y
34 E:] Other — Specify 42 Public or private company
�".
43 ❑ Private (well, cistern) K. NUMBER OF OFF-STREET
PARKING SPACES
51. Enclosed ....................... r
F. PRINCIPAL TYPE OF HEATING FUEL I. TYPE OF MECHANICAL O
35 ❑ Gas Will there be central air 52. Outdoors........................ I
36 Oil conditioning? L. RESIDENTIAL BUILDINGS ONLY
37 ❑ Electricity 44 ❑ Yes 45 E� No 53. Number of bedrooms..............
38 ❑ Coal
39 E:] Other — Specify Will there be an elevator? Full..........
54. Number of
46 ❑ Yes 47 No bathrooms
Partial.......
n
r
I hereby certify that the proposed work is authorized 6Y It -a"-e of -record
and 1 have been authorized by the owner to make this application as his
authorized agent.
SIGNATURE OF AGENT
ADDRESS
(NUMBER) (STREET) (CITY)
APPROVED BY TITLE
DATE l9
1 Z Q DEPT. FILE COPY
X Cit of Nortam p ton BUILDING a
a
Massaahuettes PERMIT
VALIDATION
DATE A=il 14. 19 22 _ PERMIT NO. 1OA
APPLICANT ROBERT SKROGKI ADDRESS RT. 66. Westhampton
(NO.) (STREET) (CONTR'S LICENSE)
ft�+
NUMBER OF
PERMIT TO NEW SINGLE RE—MENCE—) STORY R�.SIDENTIAL DWELLING UNITS 1
(TYPE OF IMPROVEMENT) NO. (PROPOSED USE)
ZONING
AT (LOCATION ROATI DISTRICTr-----
N0.) (STREET)
w BETWEEN AND
fo (CROSS STREET) (CROSS STREET) _
w
LOT
B' SUBDIVISION LOT BLOCK SIZE
M
a
v BUILDING IS TO BE FT, WIDE BY FT. LONG BY FT. IN HEIGHT AND SHALL CONFORM IN CONSTRUCTION
O
m
Z TO TYPE USE GROUP BASEMENT WALLS OR FOUNDATION
(TYPE)
REMARKS: NEW MGM. RIM-MENC.-E!
VOLUME ESTIMATED COST $ 35,000 FEEMIT $ -ins-nn
(CUBIC/SQUARE FEET)
OWNER }doh rt Skranki BUI
ADDRESS Rt 661, Wass ^mntan- Mai 01022 BY
(Affidavit on reverse side of application to be completed by authorized agent of owner)