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r2:—jVV4) 34 0 v
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 APEBP — 669 CI969 BUILDING OFFICIALS & CODE ADMINISTRATORS INTERNATIONAL, INC.
€x
IV. IDENTIFICATION - To be completed by all applicants
Name Maili address — Number treet, city, and State ZIP code Tel. No.
1.
7
Owner or `
Lessee /, � 4
411°T3+ /" .' F Builder's
2.
1/1/14) 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 p icant 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
9 Fee Started y Approved y
BUILDING $
PLUMBING $
-
MECHANICAL $
ELECTRICAL $
OTHER $
VI. ADDITIONAL PERMITS REQUIRED OR OTHER JURISDICTION APPROVALS
Permit or Approval Check Obtained Number By Permit or Approval Check Obttaitned 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 /, s n FOR DEPARTMENT USE ONLY
Permit number
Building
Permit issued Use Group
19�
Building $ //6260 0
Fire Grading
Permit Fee / V
Live Loading
Certificate of Occupancy $ Occupancy Load
Ap- ove• .y:
Drain Tile $ e `r
Plan Review Fee $ /r
TITLE
CITY OF NORTHAMPTON !' " r ��q0
MASSACHUSETTS
AA��.. )1; j
, i ;(� OFFICE of the INSPECTOR of BUILDINGS
g /1 Plot
k`: P a e
..�� APPLICATION FOR
INSPECTOR ZONING PERMIT AND
BUILDING PERMIT
IMPORTANT — Applicant to complete all items in sections: I, II, Ill, IV, and IX. 0
I. 6'3 ���ttt �j
AT (LOCATION) I/!!�J- I�"� ZONING DISTRIC
LOCATION (NO.) (STREET)
OF BETWEEN AND
BUILDING (CROSS STREET) (CROSS STREET)
LOT
SUBDIVISION LOT BLOCK SIZE
II. TYPE AND COST OF BUILDING — All applicants complete Parts A — D -i
A. TYPE OF IMPROVEMENT D. PROPOSED USE — For"Wrecking" most recent use m
m
1 I I New building Residential Nonresidential
2 I I Addition(If residential, enter number 12 4 One family 18 I Amusement, recreational
of new housing units added, if any,
in Part D, 13) 13 I I Two or more family — Enter 19 I Church, other religious
3 I�
p number of units— — — — —0- 20 Industrial
nJ Alteration (See 2 above) 14 I I Transient hotel, motel, ��
21 I Parking garage
4 I I Repair, replacement or dormitory — Enter number
5 I I Wrecking Hi multifamily residential, of units — —0.- 22 Service station, repair garage
enter number of units in building in 15 I Garage 23 I Hospital, institutional
Part D, 13)
16 I I Carport 24 n Office, bank, professional
6 I I Moving (relocation)
17 I Other — Specify 25 I Public utility
7 I Foundation only 26 ] School, library, other educational
B. OWNERSHIP 27 I Stores, mercantile
8 Private (individual, corporation,
28 I Tanks, towers
nonprofit institution, etc.) 29 Other — Specify
9 I I Public (Federal, State, or
local government)
C. COST (Omit cents) Nonresidential — Describe in detail proposed use of buildings, e.g., food
9� /yi processing plant, machine shop, laundry building at hospital, elementary
10. Cost of improvement $ `�S _ 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 1
a. Electrical '�J��
b. Plumbing LVv
c. Heating, air conditioning
d. Other (elevator, etc.)
11. TOTAL COST OF IMPROVEMENT $ 3/3,3 -
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 p``
30 I I Masonry (wall bearing) 40 Public or private company 48. Number of stories L
31 ' Wood frame 41 Private (septic tank, etc.) 49. Total square feet of floor area,
all floors, based on exterior 4'/-
f_)
32 Structural steel _ dimensions i+
33 I I Reinforced concrete H. TYPE OF WATER SUPPLY
34 I I Other — Specify 42 y Public or private company 50. Total land area, sq. ft.
43 I I Private (well, cistern) K. NUMBER OF OFF-STREET
PARKING SPACES
51. Enclosed
F. PRINCIPAL TYPE OF HEATING FUEL I. TYPE OF MECHANICAL
35 I Gas Will there be central air 52. Outdoors
36 1_1 Oil conditioning? 3
L. RESIDENTIAL BUILDINGS ONLY
37 r 1 Electricity 44 J Yes 45 Xr1 No 53. Number of bedrooms
38 Li Coal �f� 0-
39 ' Other — Specify ` 0 -L� Will there be an elevator? .
Full......
54. Number of
46 L Yes 47gi No bathrooms `�f
�'°`���°°°tttt� Partial Co