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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