17A-284 (9) VIII. ZONING PLAN EXAMINERS NOTES
DISTRICT
USE
FRONT YARD
SIDE YARD SIDE YARD
REAR YARD
NOTES
IX. SITE OR PLOT PLAN — For Applicant Use
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BOCA FORM APESP — 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.
Owner or C� Qc LCI" 1� itia ! �C` ' ?bi f.- -- r T S
Lessee
Bui Ider's
2. tCC Y- L i f 'It.-�— 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 applicant 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 Is
OTHER Is
VI. ADDITIONAL PERMITS REQUIRED OR OTHER JURISDICTION APPROVALS
Permit or Approva I Check Obt Date
ed 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 _ CGuei. J 19 _
Building �— Fire Grading
Permit Fee $ -3(& 2!! _ Live Loading
Certificate of Occupancy $ — Occupancy Load
Approved by:
Drain Tile
$ - /it
Plan Review Fee $
TITLE
NOTES and Data — (For department use)
City of Northampton
Massachusetts
Office of the Inspector of Buildings APPLICATION FOR
PLAN EXAMINATION AND
174 -- __2s BUILDING PERMIT
IMPORTANT — Applicant to complete all items in sections. 1, 11, 111, IV, and IX. p NING I. AT (LOCATION) iC/ 7 � 4�%� /`I G' `t�6 ��4. OIOSTR CI
LOCATION (STREET)
OF BETWEEN AND
BUILDING (CROSS STREET) (CROSS STREET)
LOT
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
--1
1 ❑ New building Residential Nonresidential
2�54 Addition(If residential, enter number 12 ❑ One family 18❑ Amusement, recreational
of new housing units added, if any,
in Part D, 13) 13 MTwo or more family — Enter 19 ❑ Church, other religious
number of units— — — — --ri � 20 Industrial
3 Alteration (See 2 above) 14 ❑ Transient hotel, motel, ❑
21 ❑ Parking garage
4❑ Repair, replacement or dormitory — Enter number
5 ❑ Wrecking (If multifamily residential, of units ——————— — --0. 22❑ Service station, repair garage
enter number of units in building in 15 ❑ Garage 23❑ Hospital, institutional
Part D, 13)
6 Moving (relocation)
16 ❑ Carport 24❑ Office, bank, professional
❑
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•,,,•,,••,,•,,,, /� ��� 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.).............
11. TOTAL COST OF IMPROVEMENT 1$ '
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................
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 Public or private company 50. Total land area, sq. ft. ..P.4,141.1,.
43 ❑ Prlvaie (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 Q No bathrooms ,
Partial....... G..�
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I hereby certify that the proposed work is authorized by the owner of record
and I have been authorized by the owner to make this application as his ,> `
authorized agent.
e
SIGNATURE 00 AGENT
.ADDRESS , -- -
(NUMBER) (STREET) - (CITY)^
APPROVED BY TITLE
DATE 19
r ,
DEPT. FILE COPY
ZO
a
DDEPT OF BUILDING INSPEC�ON BUILDING a
21.2 Main Street S PERMIT VALIDATION
17A - 284
Northampton, Mass. O1060 q
DATE August 18, 19 78 PERMIT NO. 348
APPLICANT Sher rl A_ Crnhnn ADDRESS 21}Fi ChPGtnut St Fl r)-
(NO.) (STREET) (CONTR'S LICENSE)
PERMIT TO AdCLt1OY1 NUMBER OF
( 2 ) STORY Residence DWELLING UNITS 2
(TYPE OF IMPROVEMENT) NO. (PROPOSED USE)
ZQNING TTR A
AT (LOCATION) 246-8 ("hPsItn17t Street F1C) - DIST RICT
(NO.) (STR_ET)
0. BETWEEN AND
a (CROSS STREET) (CROSS STREET)
LOT
n SUBDIVISION LOT BLOCK SIZE
m
e
V0 19@UEU IS TO BE 16 FT. WIDE BY 22 FT. LONG BY FT. IN HEIGHT AND SHALL CONFORM IN CONSTRUCTION
m
O I
Z TO TYPE USE GROUP BASEMENT WALLS OR FOUNDATION
(TYPE)
LL REMARKS: Ad(9i ti on to rPS'l dnnne
AREA OR PERMIT
VOLUME ESTIMATED COST . 12 non FEE 36.00
CUBIC/SQUARE FEET) Al
OWNER ShPrerl Q_ Grabon_ _
,,1'46 BOIL
2
ADDRESS 12hestnut. St. Fl n BY
(Affidavit on reverse side of application to be completed by authorized agent of owner)