29-355 (5) VIII. ZONING PLAN EXAMINERS NOTES
DISTRICT
USE —
FRONT YARD
SIDE YARD SIDE YARD
REAR YARD
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IX. SITE OR PLOT PLAN — For Applicant Use
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BOCA FORM APEBP — 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.
r /
Owner or
Lessee ./
C Builder's
2 J 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.
Signs ure of applicant j Address Application date
10 0 NOT WRITE BELOW THIS LINE /
V. PLAN REVIEW RECORD — For office use
Plan Review Date Plans B Date Plans
Plans Review Required Check Fee Started y Approved BY Notes
BUILDING
PLUMBING
MECHANICAL S
ELECTRICAL
OTHER Is
VI. ADDITIONAL PERMITS REQUIRED OR OTHER JURISDICTION APPROVALS
Approval Check Date Number m Approval Check N
Date
Permit or A umber B
PP Obtained N b B y Permit or A pp Obtained y
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
r Permit issued "2' 19
( Fire Grading
Building
Permit Fee $ Live Loading
Occupancy Load
Certificate of Occupancy
Approved by:
Drain Tile $
Plan Review Fee $
° Tom. ITL,E
a
NOTES and Data — (For department use) r-
_ s
.' 3 _Y S�
* CITY OF NORTHAMPTON
OFFICE OF THE INSPECTOR OF BUILDINGS
212 MAIN STREET APPLICATION FOR
NORTHAMPTON, MA. 01060 PLAN EXAMINATION AND
BUILDING PERMIT
IMPORTANT — Applicant to complete all items in sections' 1, 11, 111, IV, and IX. O
ZONING
I• AT (LOCATION) �"> , ter n / W--✓�' DISTRICT
LOCATION (NO.) (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
m
1 ❑ New building Res' ntial Nonresidential
2 ❑ Addition(If residential, enter number 1 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
A
3 lteration (See 2 above)
number of units- - - - -+. 20 ❑ Industrial
14 ❑ Transient hotel, motel, 21 ❑ Parking garage
4 ❑ Repair, replacement or dormitory - Enter number 22 Service station, repair garage
5 F-1 Wrecking (If multifamily residential, of units ------- - -tt
enter number of units in building in 15 ❑ Garage 23 ❑ Hospital, institutional
Part D, 13)
16,E Carport 24❑ Office, bank, professional
6 ❑ Moving (relocation)
17 Other - Specify 25 ❑ Public utility
7 [_-] Foundation only
�
} ❑ School, library, other educational
B. OWNERSHIP - ❑ Stores, mercantile
8 ❑ Tanks, towers Private (individual, corporation,
nonprofit institution, etc.) � /n ^�'1 � `- 29 ❑ Other - Specify
9 ❑ Public (Federal, State, or a
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•••••••,•....... Ll (� 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 $
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) 40X Public or private company 4• Number of stories.............
311 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 42j)e Public or private company 50. Total land area, sq. fT. ...........
43 ❑ Private (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 BUILDINGNLY
37 Electricity 44 ❑ Yes 45 No 53. Number of bedrooms....
38 Coal
39❑ Other - Specify Will there be an elevator? 54. Number of Full..........
46 ❑ Yes 47 No bathrooms
Partial.......
I hereby certify that the proposed work is authorized by the owner of record ` sow
and 1 have been authorized 'by the owner to make this application, as his
authorized agent.
SIGNATURE 0 AGENT
C— f u
ADDRESS
(NUMBER) (STREET) (CITY)
APPROVED BY TITLE
DATE 19 _
DEPARTMENT OF BUILDING INSPECTIONS Y rf- Z /V'/`, PT. FILE COPY
21 S'PEEET o a `/
N>? n. mho BUILDING
PERMIT VALIDATION
29 — 355 Code #79
DATE November 2, ig7_ PERMIT NO. 633
APPLICANT Cynthia Hanle] ADDRESS 6 Austin Flo•
(NO.) (STREET) (CONTR•S LICENSE)
ohimne y & stove 1 For WGOdrbuim stove NUMBER OF 1
PERMIT TO (`) STORY DWELLING UNITS
(TYPE OF IMPROVEMENT) NO. (PROPOSED USE)
ZONING
AT (LOCATION) 6 A18tin Circle - - DISTRICTtIRA
(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 SHALL CONFORM IN CONSTRUCTION
TO TYPE USE GROUP BASEMENT WALLS OR FOUNDATION
(TYPE)
REMARKS: Juatall exterior meona= chimney & woodmburzl= stove
AREA
VOLUME ESTIMATED COST $ 650.00 FEEMIT $ 10.00
(CUBIC/SQUARE FEET)
OWNER CYR't a r
ADDRESS 6 Avatin CrelA. nciranna, Ma. 01060 BYI DIN DEPT.
(Affidavit on reverse side of application to be completed by outho ed agent of owner)