29-388 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 C1969 BUILDING OFFICIALS & CODE ADMINISTRATORS INTERNATIONAL, INC.
imam 14 IDENTIFICATION — To be completed by all applicants
Name Mailing address — Number, street, city, and State ZIP code Tel. No.
Owner or
Lessee
Builder's
2. License No.
Contractor iy
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.
Si ureure of applicant Address Application dilate
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
Fee Started Approved
BUILDING $
PLUMBING $
MECHANICAL $
ELECTRICAL $
OTHER $
VI. ADDITIONAL PERMITS REQUIRED OR OTHER JURISDICTION APPROVALS
Date Date
Permit or Approval Check Obta ned 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 I OTHER
VII. VALIDATION
Building FOR DEPARTMENT USE ONLY
Permit number
Building Use Group
Permit issued rya ;�19 � Fire Grading
Building /
Permit Fee $ Z4(5� I)- Ua Live Loading
Certificate of Occupancy $ Occupancy Load
Approved by:
Drain Tile $
Plan Review Fee $
LE
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
BUILDING PERMIT
z
IMPORTANT — Applicant to complete all items in sections: 1, 11, 111, IV, and IX. O
�(••!!� `�j ZONING
I• AT (LOCATION) DISTRIC
LOCATION (NO.) (STREET)
OF BETWEEN AND
BUILDING (CROSS STREET) (CROSS STREET)
LOT
SUBDIVISION LOT BLOCK SIZE
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
1 New building Residential Nonresidential
2 ❑ Addition(If residential, enter number 12XOne 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 ❑ Alteration (See 2 above)
14❑ Transient hotel, motel, 21 ❑ Parking garage
4 ❑ Repair, replacement or dormitory — Enter number
5 ❑ Wrecking (If multifamily residential, of units ——————— — -� 22 Service station, repair garage
enter number of units in building in 15 ❑ Garage 23 ❑ Hospital, institutional
Part D, 13) ❑
16 Carport 24❑ Office, bank, professional
6 ❑ Moving (relocation)
179 Other — Specify 25 ❑ Public utility
7 ❑ Foundation only
ADnJe �/ Q' 26 ❑ School, library, other educational
B. OWNERSHIP / /t /1 27 ❑ Stores, mercantile
8 ❑ Private (individual, corporation, l 28 ❑ Tanks, towers
nonprofit institution, etc.) � Cd 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 1$
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) 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 dimensions .....................
33 ❑ Reinforced concrete H. TYPE OF WATER SUPPLY
34 ❑ Other — Specify 42KPublic or private company 50. Total land area, sq. ft. ...........
43 F__j Private(well, cistern) K. NUMBER OF OFF-STREET
PARKING SPACES
51. Enclosed .......................
F. PRINCIPAL TYPE OF HEATING FUEL I. TY E OF MECHANICA
35 ❑ Gas Will th a be central air 52. Outdoors........................
36 ❑ Oil conditions ? L. RESIDENTIAL BUILDINGS ONLY
37WElectricity 44 ❑ Yes 45 ❑ No 53. Number of bedrooms..............
38 ❑ Coal
39 ❑ Other — Specify Will there a an eleva ? Full..........
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.
SIGNATURE OF AGENT
ADDRESS
(NUMBER) (STREET). (CITY)
APPROVED BY TITLE
DATE 19
r t
DEPT. FILE COPY
DEPARTMENT OF BUILDING INSPECTIONS BUILDING as
212 MAIN STREET L PERMIT NORTHAMPTON• MAC 01060 V
ALIDATION
29 388
DATE Juna 5. is 80 PERMIT NO. 294 —
APPLICANT Terrance TnugAS ADDRESS 52 Brocl WoA Drive
(NO.) (STREET) (CONTR'S LICENSE)
NUMBER OF
PERMIT TO Stora¢e Shed {_�) STORY DWELLING UNITS
(TYPE E . IMPROVEMENT) N0. (PROPO D USE)
ZONING
AT (LOCATION) 52 Brookwood DriyP_ DISTRICT—
(NO.) (STREET)
m BETWEEN AND
'o (CROSS STREET) (CROSS STREET)
a
LOT
m
SUBDIVISION LOT BLOCK SIZE
U
O BUILDING IS TO BE FT. WIDE BY - FT. LONG BY FT. IN HEIGHT AND SHALL CONFORM IN CONSTRUCTION
fG
O
Z TO TYPE USE GROUP BASEMENT WALLS OR FOUNDATION
F (TYPE)
It
o REMARKS: Wood steragp shed Af X Al
AREA OR VOLUME ESTIMATED COST $ 30n.an FEEMIT it) 00
(CUBIC/SQUARE FEET)
OWNER Tarranifta Tougas BUILDI G D T.
ADDRESS 52 Arankgood Dr3yP. N*tninj � Mai BY
!Affidavit on reverse side of application to be completed by auth agent of owner)