17C-268 (2) Vill. ZONING PLAN EXAMINERS NOTES
DISTRICT
SIDE YARD SIDE YARD
IX. SITE OR PLOT PLAN For Applicant Use
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NOTES and Data — (For department use)
IV. IDENTIFICATION — To be completed by all applicants
Name Mailing address — Number, street, city, and State ZIP code Tel. No.
Owner or
Lessee
Builder's
2. <4, .. x „a t License No.
7 L
Contractor
3.
Architect or
Engineer f.
I hereby certify that the prop sed work is authorized by the finer 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 pplicant Address Application date
f
DO NOT WRITE BELOW T S 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 is
ELECTRICAL $
OTHER $
V1. ADDITIONAL PERMITS REQUIRED OR OTHER JURISDICTION APPROVALS
Date D
Permit or Approval Check Obtained Number By Permit or Approval Check Obttait ed 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
BuildingO 19 L— use crap
Permit issued 0001"', ff
Building 0c) Fire Grading
Permit Fee $
Live Loading
Certificate of Occupancy $ Occupancy Load
Appro
Drain Tile $
Plan Review Fee $
TITLE
CITY OF NORTHAMPTON
B. .� MASSACHUSETTS
f OFFICE of �t"hhe/� INSPECTOR of BUILDINGS
Page Plot APPLICATION FOR
ZONING PERMIT AND
INSPECTOR BUILDING PERMIT
z
IMPORTANT — Applicant to complete all items in sections: 1, 11, 111, IV, and IX. O
,/� ZONING
I AT (LOCATION) ,.� f - DISTRICT
LOCATION (NO.)
OF P BETWEEN F AND
) (CROSS STREET)
(CROSS STREET) I�
LOT m +ti
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(If residential, enter number 12❑ One family 18 ❑ Amusement, recreational
of new bousing units added, if any,
in Part D, ]3) 13 Two or more family — Enter � 19❑ Church, other religious
number of units— 20❑� Industrial
3Alteration (See 2 above)
14 ❑ Transient hotel, motel, 21 �� Parkin
4 Repair, replacement or dormitory — Enter number 9 garage
5 ❑ Wrecking (If multifamily residential, of units ——————— — —� 22 ❑ Service station, repair garage
enter number of units in building in 15 ❑ Garage 23 ❑J 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
❑B 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,,,,,,,,,,,,,,,, 410 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 I' 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 $ 3t0f-0C)
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 /
30 ❑ Masonry (wall bearing) 40 Public or private company 48. Number of stories................
49
31 Wood frame 41 L—] Private (septic tank, etc.) . Total square feet floor area,
all floors, based on exterior
32 ❑ Structural steel dimensions .....................
33 ❑ Reinforced concrete H. TYPE OF WATER SUPPLY
34 ❑ Other — Specify 42 Public or private company 50. Total land area, sq. ft. ..........
43 ❑ Private (we I, 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........................
conditioning?
36 ❑ Oil L. RESIDENTIAL BUILDINGS ONLY
37 j Electricity 44 [—] Yes 45 Jo /
53. Number of bedrooms..............
38 ❑ Coal t
39 ❑ Other — Specify Will there be an elevator? Full...(
54. Number of
46 1 Yes 47 >�No bothrooms Partial........
D1PT. OF BUILDING INSPECTIONS BUILDING °-
212 Main Street O`
Northampton, MA 01060 PERMIT <a
17C - 268 VALIDATION
DATE January 9. 19 89 PERMIT NO. 17
APPLICANT I✓nal nA'w,CnQ -_ ADDRESS P.O- Box 79. Chesterfield
(NO.) (STREET) (CONTR'S LICENSE)
NUMBER OF
PERMIT TO �l+orn+inn/Rpnair/RFYnIane131PARt Two Fgml1V DWELLING UNITS
T E M R EME T NO. (PROP03 D USE)
ZONING URB
AT (LOCATION) i 1 1 1 V St.rPet , Florence DISTRICT
(NO.) (STREET)
BETWEEN ANO
(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 alterations,repairs , replacement to existing two family dwelling
REMARKS,
AREA OR $ n PERMIT
AREA 140_00
VOLUME ESTIMATED COST 35,OM. nn
rEET)
OWNER Tom & Loretta Card k ,:. f�•'T ���' pJ a
ADDRESS
57 Lilly St. , Florence
WHITE - FILE COPY . GREEN - FIELD COPY a CANARY ^ APPLICANT COPY ■ PINK - ASSESSORS COPY P'iRf"P