29-301 (4) VIII. ZONING PLAN EXAMINERS NOTES
DISTRICT ZIP
USE ���
FRONT YARD
SIDE YARD SIDE YARD
REAR YARD
NOTES
IX. SITE OR PLOT PLAN — For Applicant User
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BOCA FORM APEBP — 669 C1969 BUILDING OFFICIALS & CODE ADMINISTRATORS ,INTERNATIONAL, INC.
I`R14DENTI ICATION — T be completed by all applicants
t Mailing address — Number, street, city, and State ZIP code Tel. No.
Owner or
Lessee
2. �/Y V� E�\1 License r'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 of applicar-4 Address Application date
143o Ck ltl�
00 NOT WRITE BELOW THIS LINE
V. PLAN REVIEW RECORD — For office use
Plans Review Required Check Plan Review Date Plans B Date Plans B Notes
9 Fee Started y Approved y
BUILDING $
PLUMBING $
MECHANICAL $
ELECTRICAL $
OTHER $
VI. ADDITIONAL PERMITS REQUIRED OR OTHER JURISDICTION APPROVALS
Date Date
Permit or Approval Check Obtained 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
&2 Permit Fee $ 1 � Live Loading
Certificate of Occupancy $ Occupancy Load
Approved by:
Drain Tile $
Plan Review Fee $
T L E
NOTES and Data — (For department use)
CITY OF NORTHAMPTON
OFFICE OF THE INSPECTOR OF BUILDINGS
212 MAIN STREET APPLICATION FOR
NORTHAMPTON, MA. 01060 PLAN EXAMINATION AND
9— 3 6 J BUILDING PERMIT
IMPORTANT — Applicant to complete all items in sections: 1, 11, 111, IV, and IX. O
ZONING
I• AT (LOCATION) DISTRICT L'r
LOCATION (N •) (STREET)
OF BETWEEN AND
BUILDING (CROSS STREET) (CROSS STREET)
LOT
SUBDIVISION LOT BLOCK SIZE
V1
II. TYPE AND COST OF BUILDING — A11 applicants complete Parts A — D
M
A. TYPE OF IMPROVEMENT D. PROPOSED USE – For"Wrecking" most recent use m
1 New building Res'd ntial Nonresidential
2 Addition(If 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– – – – -� 20 ❑ Industrial
3 F-1 Alteration (See 2 above) 14 l
l
h
i
Transent hotel, mote ,
❑ 21 ❑ Parking garage
4 ❑ Repair, replacement or dormitory – Enter number
5 ❑ Wrecking (If multifamily residential, of units ––––––– – --3a 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
7 ❑ Foundation only 17OTher – Specify 25 ❑ Public utility
26 ❑ School, library, other educational
B. OWNERSHIP � s � 27 ❑ Stores, mercantile
8jb?l Private (individual, corporation, 28 ❑ Tanks, towers
nonprofit institution, etc.) �/� L—T 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
rocessing plant, machine shop, laundry building at hospital, elementary
10. Cost of improvement••••,,••,,,,,,•• t~ ) 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.)............ 7 /{
11. TOTAL COST OF IMPROVEMENT $
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. T E OF SEWAGE DISPOSAL J. DIMENSIONS
30❑Masonry (wall bearing) 4Q 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 dimensions .....................
33 ❑ Reinforced concrete H. TYPE OF WATER SUPPLY
34❑ Other – Specify 42 Public or private company 50. Total land area, sq. fT. ...........
4Private (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........................
conditioning?
36 ❑ Oil ,��, L. RESIDENTIAL BUILDING ONLY
37X Electricity 44 ❑ Yes 4 No 53. Number of bedrooms.�� .
38 ❑ Coal \ /
39❑ Other – Specify Will there be an elevator? Full...J....
54. Number of
46 ❑ Yes 47 No bathrooms
Partial.......
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.
t.
SIGNATURE 'OF AGENT
ADDRESS
(NUMBER) (STREET) (CITY)
APPROVED BY TITLE
DATE lg
I
DEPT. FILE COPY
DEPARTMENT OF BUILDING INSPECTIONS BUILDING
Qa
212 MAIN STREET PERMIT NORTL AMP1Op9 MA. 01060 VALIDATION
29 - 301 CODE #79
DATE May $. 19 80 PERMIT NO. 231
APPLICANT Sa{p1j�],-��*Coco - ADDRESS 430 Acx
(NO.) (STREET (CONTR'S LICENSE)
NUMBER OF
( qq ) STORY DWELLING UNITS
PERMIT TO (TY E OVEMENT) O. P POSED E)
ZONING
AT (LOCATION) �t3n A�'rPbrAQk ifT3v� - DISTRICT URA
(N0.) (STREET)
r BETWEEN AND
o (CROSS STREET) (CROSS STREET)
T
LOT
L SUBDIVISION LOT BLOCK SIZE
m
Addition
p JIM=IS TO BE 7 FT. WIDE BY 14 FT, LONG BY FT. IN HEIGHT AND SHALL CONFORM IN CONSTRUCTION
a
O USE GROUP BASEMENT WALLS OR FOUNDATION
Z TO TYPE (TYPE)
2
at
O
I+. REMARKS: Addition of ""hP-At" pne1jostpd parch
AREA OR ESTIMATED COST . _���d0 FEEMIT moo
VOLUME �[w
(CUBIC/SQUARE FEET)
OWNER SAM-, RAthl se- of-=0 - CILDINp T.
ADDRESS 430 ac T'°r'mok Dreg Fl ore rte. A9 01060
(Affidavit on reverse side of application to be completed by authorized agent of owner)