17C-145 (5) ZONING ,
FRONT DISTRICT X�
USE
SIDE • . SIDE
REAR .D
IX. SITE OR PLOT PLAN For Applicant
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NOTES and Data — (For department use)
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IV. IDENTIFICATION — To be completed by all applicants ."-
Name Mailing address - \:iunhcr, street, C11N, (110 Slate ZIP code Tel. No.
._ .. .
Owner c.
Lessee {}�
�c YjtlNl IkdLF. i1a
Builder's
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 ap cant Address Application ate
,
DO 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
Permit or A rovaI ec
Chk Date Nmber By Permit or Approval Check Date Number By
PP Obtained u Obtained
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
Permit number
Building ,/ y 19
Permit issued
Building
Permit Fee $ 4�1 ----°"rt
Certificate of Occupancy S
Approved by:
Drain Tile
Plan Review Fee S_
TITLE
0
*� ti Crzty of Xort4alllpton
,� �IMSSAC�11:sCtt$
Office of the �ns}1CCto r of AuilbIligs
APPLICATION FOR
Page % `— Plot / `� ZONING PERMIT AND
9 BUILDING PERMIT
IMPORTANT — Applicant to complete all items in sections: 1, 11, 111, IV, and IX. Z
O
I• AT (LOCATION) _.✓l-�( D
ZONING
LOCATION (NO.) (STREET)
OF BETWEEN AND
BUILDING (CROSS STREET) (CROSS STREET)
LOT
SUBDIVISION LOT BLOCK SIZE
0
il. TYPE AND COST OF BUILDING — All applicants complete Parts A — D M
A. TYPE OF IMPROVEMENT D. PROPOSED USE — For"Wrecking" most recent use m
m
1 ❑ New building Residential Nonresidential
2 X Addition(If residential, enter number 12' family 18 Amusement, recreational
of new housing units added, if any, I;IOne
in Part D, 13) 13 ❑ Two or more family — Enter 19 Church, other religious
3 F__1 Alteration (See 2 above)
number of units— — — — --)�
20 Industrial
J�
14 ❑ Transient hotel, motel, 21 Parking garage
4 Repair, replacement or dormitory — Enter number
5 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)
6F_1 Moving (relocation) 16 � Carport 24 Office, bank, professional
70 Foundation only 17❑ Other — Specify 25 Public utility
26 0 School, library, other educational
B. OWNERSHIP 27 Stores, mercantile
28 Tanks, towers rr
B,,KPrivate (individual, corporation, t
nonprofit institution, etc.)
29 Other — Specify
9 F__� Public (Federal, State, or
local government)
C. COST (Omit cents) Nonresidential — Describe in detail proposed use of buildings, e.g., food J
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.)............. t
11. TOTAL COST OF IMPROVEMENT $
III. SELECTED CHARACTERISTICS OF BU LDING — For new buildings and additions, complete Parts E — L;
for wrecking, complete only Part J, for all others skip to IV. D
E. PRINCIPAL TYPE OF FRAME G. TYPE OF SEWAGE DISPOSAL J. DIMENSIONS / m
30 EA Masonry(wall bearing) 40,XPublic or private company 48• Number of stories.../ .......
31 54 Wood frame 41 E Private (septic tank, etc.) 49. Total square feet of floor area,
all floors, based on exterior
3 F—I Structurol steel dimensions ....:................
33 ❑ Reinforced concrete H. TYPE, OF WATER SUPPLY >
42
34 Other — Specify Public or private company
50. Total land area, sq. ft. 7�.4 !
43 ❑ Private(well, cistern) K. NUMBER OF OFF-STREET
PARKING SPACES
F. PRINCIPAL TYPE OF HEATING FUEL I. TYPE OF MECHANICAL 51. Enclosed ........................ r-
�_� O
35�9Gos Will there be central air 52. Outdoors......... ........... t— —
36 F-1 Oil conditioning?
L. RESIDENTIAL BUILDINGS ONLY
37 Electricity 44 [::] Yes 45 No
53. Number of bedrooms..............
38 Coal '( 1 1
39 Other — Specify Will there be an elevator? Full,!„-.?!:�.7:. )f
54. Number of
46 D 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. tQ make this applicotion- as Eris
authorized agent.
SIGNATURE OF AGENT '
ADDRESS
(NUMBER) (STREET) (CITY)
APPROVED BY TITLE
DATE 19
DEPT. FILE COPY
Zp
CITY OF NORTIATON BUILDING a a
NORTHAMPTON, MA. 01060 17C — 145 PERMIT VALIDATION
DATE April 24, 19 J`!_ PERMIT NO. 120
APPLICANT Paul D. Roberts ADDRESS 28 Keyes Street, Flo.
(NO.) (STREET) (CONTR'S LICENSE)
NUMBER OF
PERMIT TO Demolition & AlteratioxIL-t) STORY Residence DWELLIING UNITS 1
(TYPE OF IMPROVEMENT) NO. (PROPOSED USE)
ZONING R
AT (LOCATION) 28 Keyes Street DISTRICT
(NO.) (STREET)
a BETWEEN AND
m (CROSS STREET) (CROSS STREET)
01
LOT
IL SUBDIVISION LOT BLOCK SIZE
m
a
O
BUILDING IS TO BE FT. WIDE BY FT. LONG BY FT. IN HEIGHT AND SHALL CONFORM IN CONSTRUCTION
m
Z TO TYPE USE GROUP BASEMENT WALLS OR FOUNDATION
(TYPE)
m
0 REMARKS: Remove raraze & aonstruat addition to one family residence
AREA OR ESTIMATED COST $ 5.WO FEEMIT $ 15.00
VOLUME
(CUBIC/SQUARE FEET) "?
OWNER Pahl & Janice Roberts BUIL
ADDRESS 28 Keyes Streeter Florence BY -'
(Affidavit on reverse side of application to be completed by authorized agent of owner)