29-471 (7) ± 7 /
VIII. ZONING PLAN EXAMINERS NOTES
DISTRICT zz C
USE %
FRONT YARD
SIDE YARD SIDE YARD
REAR YARD
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NOTES
IX. SITE OR PLOT PLAN — For Applicant Use
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V '" 1
BOCA FORM APEBP — 669 C1969 BUILDING OFFICIALS & CODE ADMINISTRATORS INTERNATIONAL, INC.
fr Ilk L be completed by all applicants
Name Mailing address — Number, street, city, and State ZIP code Tel. No.
Owner or v
Lessee oZ 7 / G!"
r! Builder's
2. 5,16' s %'A-.l'� < 1'?s-s.�.�—�, 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.
Signatur ant Address Application date
,
DO NOT WRITE B LOW 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
Permit or A k Date Date
Number By Permit or Approval Approval Number By
PP l Chec Obtained um l Ch Obtained
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 7,
Building �� �g Use Group
Permit issued � 'w: �3 �1 19
Fire Grading
Building � � �
Permit Fee Live Loading
Occupancy Load
Certificate of Occupancy
Approved by:
Drain Tile
Plan Review Fee $ '
' TITLE
4PqPM
NOTES and Data — (For department use)
*'&a• 01�
CITY OF NORTHAMPTON
OFFICE OF THE INSPECTOR OF BUILDINGS
212 MAIN STREET APPLICATION FOR
NORTHAMPTON, MA. 01060 PLAN EXAMINATION AND
% 7� BUILDING PERMIT
z
IMPORTANT — Applicant to complete all items in sections: 1, 11, 111, IV, and IX. O
,,77,,�f/ /�/'J Z O N I N G JCk
• AT (LOCATION) T 1f9�(.' 1.�'��n DISTRICT
LOCATION (RO') / ( TREET)
OF BETWEEN AND
BUILDING (CROSS STREET) (CROSS STREET)
LOT l �'.x -c0 °
SUBDIVISION LOT BLOCK SIZE T
H
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
m
—f
1 New building Residential Nonresidential
2 Addition(I/residential, enter number 12 One family 18 ❑ Amusement, recreational
of new housing units added, if any,
in Part D, 13) 13 Two or more family — Enter 19 ❑ Church, other religious
number of units— — — — --jo. 20 ❑ Industrial
3 ❑ Alteration (See 2 above)
14 ❑ Transient hotel, motel, 21 ❑ Parking garage
4 ❑ Repair, replacement or dormitory — Enter number
units ——————— — --),- 22 ❑ Service station, repair garage
5 F-1 o Wrecking (If multifamily residential, J
enter number of units in building in 150 Garage 23 ❑ Hospital, institutional
Part D, 13)
16 ❑ Carport 24❑ Office, bank, professional
6 ❑ Moving (relocation)
17 ❑ Other — Speci/y 25 E:] 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 (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 $ U
III. SELECTED CHARACTERISTICS OF BUIUDING — 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 `S 6 xs g
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 F7 Other — Specify 42 Public or private company 50. Total land area, sq. ft. ...........
43 Private (well, cistern) K. NUMBER OF OFF-STREET
PARKING SPACE,} :!t.
S _
��......
F. PRINCIPAL TYPE OF HEATING FUEL I. TYPE OF MECHANICAL 51. Enclosed ....^.-�-�.
35 Gas Will there be central air 52. Outdoors.......................
conditioning?
36 Oil L. RESIDENTIAL BUILDINGS ONLY
37 ❑ Electricity 44❑ Yes 45 FV No 53. Number of bedrooms..............
38 F-1 Coal
39 ❑ Other — Specify Will there be an elevator? 54. Number of Full..........
46❑ Yes 47❑ No bathrooms
Partial.......
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