17A-290 (4) VIII. ZONING PLAN EXAMINERS NOTES
DISTRICT
USE
FRONT YARD
SIDE YARD -SIDE YARD
REAR YARD
NOTES
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BOCA FORM APEBP — 669 C1969 BUILDING OFFICIALS & CODE ADMINISTRATORS INTERNATIONAL, INC.
IV. IDENTIFICATION - To be completed by all applicants
Name Mailing address — Number, street, city, and State ZIP code Tel. No.
Gary L. Dill 70 Main Street, Northampton, MA 01060 586-3183
Owner or
Lessee --Judy L. Dill
2. Plantation Valley Hom s,Inc. P.O.Box 7, Florence, MA LBuiNer's
Contractor
009039
3' Ernest B. Griswold 8 Peak Road Wilbraham MA 596-6971
Architect or > >
Engineer (House Designer
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.
Signat e f applicant 1 Address Application date
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
Date Date
Permit or Approval Check Obtta 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 19 _
Building Fire Grading
Permit Fee
Live Loading
Certificate of Occupancy $ Occupancy Load
Ap ed by:
Drain Tile
Plan Review Fee
TITLE
NOTES and Data — (For department use)
SI—r as
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.r
r
CITY OF NORTHAMPTON
OFFICE OF YHE INSPECTOR OF BUILDINGS
212 MAIN STREET APPLICATION FOR
NORTHAMPTON, MA. 01060 17A — � 9L90 PLAN EXAMINATION AND
BUILDING PERMIT
z
IMPORTANT — Applicant to complete all items in sections: 1, 11, 111, IV, and IX. O
ZONING
• AT (LOCATION)
Lot 7T I./t78 V Hillcrest Drive - Florence, MA DISTRIC
LOCATION (NO.) (STREET)
OF BETWEEN Sheffield Lane AND Bridge Road
BUILDING (CROSS STREET) p (CROSS STREET)
LOT
r7
SUBDIVISION LOT I V BLOCK SIZE 31,939 S.F.
iA
II. TYPE AND COST OF BUILDING - A11 applicants complete Parts A - D
A. TYPE OF IMPROVEMENT D. PROPOSED USE - For"Wrecking" most recent use Im
IM
1 ® New building Residential Nonresidential
2 ❑ Addition(If residential, enter number 12❑X One family 18 ❑ Amusement, recreational
of new housing units added, if any, 13❑ Two or more family - Enter 19 ❑ Church, other religious
in Part D, 13) number of units- - - - -�
3 ❑ Alteration (See 2 above) 20 ❑ Industrial
14 ❑ Transient hotel, motel, 21 ❑ Parking garage
4 ❑ Repair, replacement or dormitory - Enter number
5 F1 Wrecking (If multifamily residential, of units ------- - - 22 ❑ Service station, repair garage
enter number of units in building in 15 Garage tz - �/ j 23 ❑ Hospital, institutional
Part D, 13) ❑
16 Carport 24 E] Office, bank, professional
6 ❑ Moving (relocation)
# Other - Specify 25 ❑ Public utility
7 ❑ Foundation only
26 ❑ School, library, other educational
B. OWNERSHIP 27 ❑ Stores, mercantile
8 ® Private (individual, corporation, 28 ❑ Tanks, towers
nonprofit institution, etc.) 29 ❑ Other - Specify
9 ❑ Public (Federal, State, or
local government)
C. COST ( -G ) Nonresidential - Describe in detail proposed use of buildings, e.g., food
����p�_ processing plant, machine shop, laundry building at hospital, elementary
10. Cost of improvement................ G""' 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.)............ Q
11. TOTAL COST OF IMPROVEMENT is
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................ 2
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 - SpeciJy 42 ® Public or private company 50. Total land area, sq. fT. ........... 31,939
43 ❑ Private (well, cistern) K. NUMBER OF OFF-STREET
PARKING SPACES
51. Enclosed ...................... 2
F. PRINCIPAL TYPE OF HEATING FUEL I. TYPE OF MECHANICAL
35 0 Gas Will there be central air 52, Outdoors........................ 2
36 ❑ oil conditioning? L. RESIDENTIAL BUILDINGS ONLY
37 ❑ Electricity 44 ❑ Yes 45 n No 53. Number of bedrooms.............. 3
38 ❑ Coal
39 ❑ Other - Specify Will there be an elevator? Full.......... 2
54. Number of
46 ❑ Yes 47 ® No bathrooms
Partial.......
INSPECTION RECORD
DATE NOTE PROGRESS - CRITICISMS AND REMARKS INSPECTOR
Department of Huilding Inspections FIELD COPY
212 Main Street
rtha ton, Ma. awe BUILDING ,SS'. 'Ll
17A - 290 PERMIT
DATE ..:s¢mst 25, 19 21 PERMIT NO. 191
APPLICANT ADDRESS "
(N 0.I� (STREET) (CONY R'S LICENSE)
NUMBER OF +
PERMIT TO (_NO. STORY DWELLING UNITS 3
YP M V M N NO. P�lR OPOSED USE)
ZONING
AT (LOCATION) 1t #78 Si11crest Dr4we- Flaranee DISTRICT—URA
(NO.) (STREET)
rn BETWEEN AND
(CROSS STREET) (CROSS STREET)
LOT
a SUBDIVISION LOT BLOCK SIZE
m
a
U
O BUILDING IS TO BE FT. WIDE BY FT. LONG BY FT. IN HEIGHT AND SHALL CONFORM IN CONSTRUCTION
i
m
O
Z TO TYPE USE GROUP BASEMENT WALLS OR FOUNDATION
f (TYPE)
O
REMARKS: 0-m-sm-lim-041y dwelUag *Ath attacked garages Wood tzme-v &as beat,, public sewage
disposal and public hater supply, 3 bedrooms, 2 full baths.
1st. p1.-12610 sq. ft. Garage - 288 sq. ft.
AREA OR 2nd. - 694 � � PERMIT
VOLUME ESTIMATED COST ��A',$ /1!1 FEES 7
!, (CUBIC/SQUARE FEET)
OWNER � .-I-_�
"I L. BUI
ADDRESS BY