17C-261 (8) 1
IV. IDENTIFICATION — To be completed by all applicants
Name Mailing address — Number, street, city, and State ZIP code Tel. No.
3wner or
_essee
i
BUIIder's
License No.
Contractor
Arc 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 a lication as his authorized agent and we agree to conform to all applicable laws of this jurisdiction.
Sign�ature pplicant Address Application date
00 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
Date ate
Permit or Approval Check Obtained Number By Permit or Approval Check ObDta ned 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 l r 9
Building q Use Group
Permit issued 1-
Building `/ Fire Grading
Permit Fee $ Il1'0'Lil'/ Live Loading
Certificate of Occupancy $ Occupancy Load
Approved bye:
Drain Tile $
Plan Review Fee $ C
TITLE
CITY OF NORTHAMPTON
MASSACHUSETTS
OFFICE of the INSPECTOR of BUILDINGS
Page Plot ? APPLICATION FOR
ZONING PERMIT AND
INSPECTOR
BUILDING PERMIT
z
IMPORTANT — Applicant to complete all items in sections: 1, I1, III, IV, and IX. 1C
ZONING
I• AT (LOCATION), P�i t °1 Iw P �....1 DISTRICT
LOCATION (N0.) (STREET)
OF BETWEEN Y""- "�..,�^ AND I
BUILDING (CROSS STREET) ` CROSS Sr BEET)
p LOT ; t :
SUBDIVISIONt�' f ^` LOT t.C` 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 ;rt;
4I -+
1 ❑ New building Residential Nonresidential
2 Addition(l residential, enter nrsmber
/ 12 ..One family 18 L j Amusement, recreational
of new housing units added, if any,
in Part D, 13) 13 ❑ Two or more family — Enter 19 L_� Church, other religious
j number of units— — — — 20 �� Industrial
5 3 Q Alteration (See 2 above)
14 Transient hotel, motel, 21 Parking garage
4 ❑ Repair, replacement or dormitory — tinter number
5 ❑ Wrecking (U multifamily residential, of units ——————— — --).
22 Service station, repair garage
enter number of units in building in 15 L Garage 23 Hospital, institvtionol
Part D, 13)
6 ❑ Moving (relocation) 16 [_] Carport 24 L Office bank, pro!ossional
7 ❑ Foundation only 17 L � Other -. Spc-ci/y _ 25 F � Public utility
26 School, library, other educ:,!ional
B. OWNERSHIP 27 ( ] Stores, mercantile
L_8 Private (individual, corporation, 28 Tanks, towers
nonprofit institution, etc.) 29 Other
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 of industrial plant.
7'o be installed but not included If use of existing building is being changed, enter proposed use.
in the above cost
a. Electrical.....................
b. Plumbing ..................... � -1 ,
c. Heating, air conditioning..........
d. Other (elevator, etc.).............
11. TOTAL COST OF IMPROVEMENT Is
III. SELECTED CHARACTERISTICS OF BUILDING — For " w buildings and additions, complete Ports E — L,
for wrecking, complete only Part J, for all others skip to IV.
E. PRINCIPAL TYPE OF FRAME G. TYPI1 OF SEWAGE DISPOSAL J. DIMENSIONS a -'
30❑ Masonry (wall bearing) 40�blic or private company 48. Number of stories...:........
31 Wood frame 41 Private (septic tank, etc.) 49. Total square feet of floor area, `! t
all floors, based on exterior
32 ❑ Structural steel dimensions .....................
33 ❑ Reinforced concrete H. T PE F WATER SUPPLY _
34 ❑ Other — Specify 42• blic or private company 50. Totnl Innd area, sq. ft. ...........
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 — Spccify Will there be an elevators Full.........
_ 54. Number of
46 I Yes 47 No bathrooms
`- - Partial.......
DEPT. OF BUILDING INSPECTIONS BUILDING Z° 1��
212 Main Street 0
a.
NNorthampton, KAk 01060 PERMIT
17C - 261 VALIDATION
C DATE October 14, 87 Pe �T 695
APPLICANT Thayer St. Assoc. ADDRESS �� ��
(NO.) (STREET) (CONTR'S LICENSE)
NUMBER OF
PERMIT TO Addition (_) STORY One Family DWELLING UNITS
(TYPE OF IMPROVEMENT) NO. (PROPOSED USE)
AT (LOCATION) 80 O• Main • , Florence —DISTRICT— URB
(NO.) (STREET)
BETWEEN AND
(CROSS STREET) (CROSS STREET)
LOT
SUBDIVISION LOT BLOCK SIZE
BUILDING IS TO BE FT. WIDE BY FT. LONG BY FT. IN HEIGHT AND SMALL CONFORM IN CONSTRUCTION
TO TYPE USE GROUP BASEMENT WALLS OR FOUNDATION
(TYPE)
REMARKS, permit for the addition of extra living space for single family dwelling above existing
attached garage. Per AXX ZBA Approval
AREA VOLUME 552 $Q. ft. r 1 5,000.00 PERMIT $ 60.00
ESTIMATED COST $ FEE
(CUBIC/SQUARE FEET)
OWNER Mary RXXXXParker
ADDRESS
80 North Main St. , Florence BY"
jab
WHITE - FILE COPY . GREEN - FIELD COPY • CANARY ^ APPLICANT COPY • PINK ^ ASSESSORS COPY lop