17C-257 (2) VIII. ZONING PLAN EXAMINERS NOTES
DISTRICT
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NOTES
IX. SITE OR PLOT PLAN — For Applicant Use
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BOCA FORM APEBP — 669 01969 BUILDING OFFICIALS & CODE ADMINISTRATORS INTERNATIONAL, INC.
M
-N IV. IDENTIFICATION — To be completed by all applicants
Name Mailing address — Number, street, city, and State ZIP code Tel. No.
(� r K� c �i a-ct�Q. V c 311 .0j y6j
Owner or O y�(L'v
Lessee
2.
(( License No. ,6 q4411
Contractor r2t .44 ®Z 04 _
3. oZ �O
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.
Sig ature of applicant Address Application date
00 NOT WRITE BELOW THIS LINE
V. PLAN REVIEW RECORD — For office use
Plans Review Required Check Plan Review Date Plans B Date Plans B Notes
q Fee Started y Approved y
BUILDING
PLUMBING
MECHANICAL
ELECTRICAL
OTHER
VI. ADDITIONAL PERMITS REQUIRED OR OTHER JURISDICTION APPROVALS
Date Date
Permit or Approval Check Obta ned 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 FOR DEPARTMENT USE ONLY
Permit number
Building Use Group
Permit issued r 19�
Building Fire Grading
Permit Fee $ Live Loading
Certificate of Occupancy $ Occupancy Load
Approved by:
Drain Tile
Plan Review Fee
TI
NOTES and Data — (For department use)
I
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CITY OF NORTHAMPTON
OFFICE OF THE INSPECTOR OF BUILDINGS '' J
212 MAIN STREET , . APPLICATION FOR
NORTHAMPTON, MA. 01060 I� i PLAN EXAMINATION AND
BUILDING PERMIT
z
IMPORTANT — Applicant to complete all items in sections: I, 11, 111, IV, and IX. o
1� A/oRTli r '/ C'C'T tgl/lj Sif ZONING
I• AT (LOCATION) �/� /l _. 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 F-1 New building Resid ntial Nonresidential
2 k Addition(If residential, enter number 12 KOne family 18 ❑ Amusement, recreational
of new housing units added, if any,
in Part D, 13) 13 F-1 Two or more family - Enter 19 ❑ Church, other religious
number of units- - - - •->
3 F-1 Alteration (See 2 above) 20 ❑ Industrial
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) ❑
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, merconti le CA
8 Private (individual, corporation, 28 ❑ Tanks, towers
nonprofit institution, etc.) 11��� 29 ❑ Other - Specify rl%l
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 (J
a. Electrical.....................
b. Plumbing .....................
C. Heating, air conditioning..........
d. Other(elevator, etc.)............
11. TOTAL CIPST OF IMPROVEMENT $ Q1
III. SELECTED CHARACTERISTICS OF BUILDING — For new buildings and additions, complete Parts E — L; O
for wrecking, complete only Part J, for all others skip to IV. 6�
O
E. PRINCIPAL TYPE OF FRAME G. TYPE OF SEWAGE DISPOSAL J. DIMENSIONS F
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-] Public or private company 50. Total land area, sq. ft. ...........
43 F-1 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 ❑ No 53. Number of bedrooms..............
38 ❑ Coal
39 ❑ Other- Specify Will there be an elevator? Full..........
54. Number of
46 ❑ Yes 47❑ No bathrooms
Partial.......
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I hereby certify that the.-proposed, work is authorized by the owner 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 19
DEPARTMENT OF BUILDING INSPECTIONS Z DEPT. FILE COPY
�
212 MAIN STREET ��'����� 04
NORTHAMPTON, MA, 0'1060 MM
PERMIT VALIDATION
17C - 257
DATE June 190 19 79 PERMIT NO. 28P
APPLICANT Karen Jcs=h ADDRESS 50 North Mnin StrP.Pt, F9 renne
(N0.) (STREET) (CONTR•S LICENSE)
NUMBER OF
PERMIT TO Chimne..y e__2__) STORY For WOOC�—UUrna R_ I� nVe_ DWELLING UNITS 1
(TYPE OF IMPROVEMENT) NO. (PROPOSED USE)
AT (LOCATION) 50 North Main ZONING
DISTRICT jTRR
(NO.) (STREET)
rn BETWEEN AND
a (CROSS STREET) (CROSS STREET)
IL LOT
m SUBDIVISION LOT BLOCK SIZE
a
0 BUILDING IS TO BE FT. WIDE BY FT. LONG BY FT, IN HEIGHT AND SHALL CONFORM IN CONSTRUCTION
O
M
O
Z TO TYPE USE GROUP BASEMENT WALLS OR FOUNDATION
f
� (TYPE)
LL REMARKS: Rrink nhimnPy frith P flues, one in hac;PmPnt Rr n-np on first flnnr_
Brickwork & hearth construction in livingroom. Installation of
two wood stoves.
AREA OR PERMIT
VOLUME ESTIMATED COST $ 850.0O FEE 10.00
(CUBIC/SQUARE FEET)
OWNER Cl a.rPneP &.. Kasen .Tn:aPn'h
BUILD] G
ADDRESS 50 No. Main Street, Florence, Ma. BY
(Affidavit on reverse side of application to be completed by authorized agent of owner)