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DISTRICT of
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NOTES
IX. SITE OR PLOT PLAN — For Applicant Use
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BOCA FORM APEBP — 669 C1969 BUILDING OFFICIALS & CODE ADMINISTRATORS INTERNATIONAL, INC.
IWa. IDENTIFICATION — To be completed by all applicants
Name Mailing address — Number, street, city, and State ZIP code Tel. No.
Owner or 0 1 601
Lessee
n Builder's
r r �n f F �, / 1 �, 5 L'��/` i License No.
2. ,M, F'�1wf�t�uc,� �., 'S t �� !v ��. ,
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 applicant Address Application date
DO NOT WRITE BELOW THIS LINE
V. PLAN REVIEW RECORD — For office use
Plan Review Date Plans Date Plans
Plans Review Required Check Fee Started By Approved By Notes
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 L Use Group
Permit issued 7"x,., � -- 19�
Fire Grading
Building
Permit Fee � +'� h�� Live Loading
Occupancy Load
Certificate of Occupancy
Approved by:
Drain Tile
Plan Review Fee
TI
NOTES and Data — (For department use)
P'
y
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t
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, II, III, IV, and IX. 0
ZONING
DISTRICT
I• AT (LOCATION)
LOCATION (N 0.) (STREET)
OF BETWEEN AND
BUILDING (CROSS STREET) (CROSS STREET)
LOT
SUBDIVISION LOT BLOCK SIZE
H
il. TYPE AND COST OF BUILDING — All applicants complete Parts A — D
M
A. TYPE OF IMPROVEMENT D. PROPOSED USE — For"Wrecking" most recent use m
1 ❑ New building Re dential Nonresidential
2� Addition(If residential, enter number 12K'One family 18 ❑ Amusement, recreational
of new housing units added, if any, 13❑ Two or more family — Enter 19 ❑ Church, other religious
in Part D, 13)
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) r� ❑ y
17� Other — Specify �� �n� 25 Public utility
7 ❑ Foundation only 26 ❑ School, library, other educational
B. OWNERSHIP / 27 ❑ Stores, mercantile
28 ❑ Tanks, towers
8� Private (individual, corporation,
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,,,,,•••........ GG school, secondary school, college, parochial school, parking garage for,
deportment 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.....................
r;.
b. Plumbing .....................
c. Heating, air conditioning..........
d. Other(elevator, etc.)............
11. TOTAL COST OF IMPROVEMENT $ 5 i
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 y
48. Number of stories....�..Ad Masonry (wall bearing) 40 49. Total square feet of floor area,Public or private company
31 Wood frame 41 ❑ Private (septic tank, etc.) all floors, based.o extff��io
32 Structural steel dimensions ..� t.;...y
33❑ Reinforced concrete H. TYPE OF WATER SUPPLY
34❑ Other — Specify
42 Public or private company 50. Total land area, sq. ft. ...........
43 Private(well, cistern) K. NUMBER OF OFF-STREET
PARKING SPACES
51. Enclosed ......................
F. PRINCIPAL TYPE OF HEATING FUEL I. TYPE OF MECHANICAL
35 J Gas Will there be central air 52. Outdoors........................
36 6 oil�` conditioning?
❑ L. RESIDENTIAL BUILDINGS Y
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 bathrooms
No Partial........
hereby certify that the
y y proposed :work is authorized by the owner b� 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
Ile, .
• yr
DEPT. FILE COPY
DEPARTMENT OF BUILDING INSPECTIONS Zo
Od
NO roN�. 01060 BUILDING
PERMIT VALIDATION
29 — 214 Code #79 ',
DATE November -6 19 79 PERMIT NO. 6'48
APPLICANT RTi an White ADDRESS (NO.17 AQreb=ok Drive (cQNTR s LICENSE)
NUMBER OF
PERMIT TO AddItiom ( 2 STORY Sunporoh DWELLING UNITS 1
(TYPE OF IMPROVEMENT) NO. (PROPOSED USE)
ZONING t �
AT (LOCATION) 197 AQTebrook Driya -- --- DISTRICT -
(NO,) (STREET)
a BETWEEN AND
v (CROSS STREET) (CROSS STREET)
P
LOT
e SUBDIVISION LOT BLOCK SIZE
Addition
Q XXXTIM IS TO BE 16 FT. WIDE BY 22 FT. LONG BY FT. IN HEIGHT AND SHALL CONFORM IN CONSTRUCTION
■
Z TO USE GROUP BASEMENT WALLS OR FOUNDATION
� (TYPE)
Q
O
L- REMARKS; —Addition of aumorch
L
AREA OR FEEMIT
VOLUME ESTIMATED COST
(CUBIC/SQUARE FEET)
L OWNER Rri 1jibitx- BADDRESS 117 Aorebrook Drive. N'ton.a Ma.. B(Affidavit on reverse side of application to be completed by a ent of owner)