29-286 (6) 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 01969 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.
Owner or )U�,O LI/� d I -- GIDS<o Orkr
Lessee
Builder's
2, 1 6( d License No.
Contractor
3.
Architect or
Engineer
I hereby certify that the proposed work is autho�r`iz7ed by the owner o 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
00 NOT WRITE BELOW THIS LINE
V. PLAN REVIEW RECORD — For office use
Plans Review Re wired Check Plan Review Date Plans B Date Plans B Notes
q Fee Started y Approved y
BUILDING $
PLUMBING $
MECHANICAL $
ELECTRICAL $
OTHER $
VI. ADDITIONAL PERMITS REQUIRED OR OTHER JURISDICTION APPROVALS
Date Date
Permit or Approva I 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 f} Use Group
Permit issued _ C'�. �CC_`f 19
T
Building Fire Grading
Permit Fee C� Live Loading
Certificate of Occupancy $ Occupancy Load
Approved by:
Drain Tile $
Plan Review Fee $
TI
NOTES and Data — (For department use)
t
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
• AT (LOCATION) D�/ _5)� L� D 3TR CTI�1
LOCATION (NO.) (STREET
BETWEEN AND
BUILDING (CROSS STREET) (CROSS STREET)
SUBDIVISION LOT LOT
BLOCK SIZE
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 _q
Resi�de}tial Nonresidential 2Addition(If residential, enter number 12•},,/)One family 18❑ Amusement, recreational
of new housing units added, if any, s`�• f
in Part D, 13) 13 ❑ Two or more family — Enter 19❑ Church, other religious 6
3 Alteration (See 2 above)
number of units— — — — -.� 20 E] Industrial❑
4
14 E] Transient hotel, motel, 21 ❑ Parking garage
❑ Repair, replacement or dormitory — Enter number n
5 ❑ Wrecking (If multifamily residential, of units ——————— — -� 22 ❑ Service station, repair garage \'
enter number of units in building in 15 ❑ Garage 23 ❑ Hospital, institutional
Past D, 13)
6 ❑ Moving (relocation)
16 ❑ Carport 24❑ Office, bank, professional
7❑ Foundation only
17 Other — Specify t 25❑ Public utility
26❑ School, library, other educational
B. OWNERSHIP 27 ❑ Stores, mercantile
8 A 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.)............. I
11. TOTAL COST OF IMPROVEMENT $
III. SELECTED CHARACTERISTICS OF BU LDING — 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 sonry (wal I 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 fYF WATER SUPPLY
34❑ Other — Specify 4 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�entral a' 52. Outdoors.......................
36 ❑ I conditioning?
L. RESIDENTIAL BUILDINGS ONLY
37 Electricity 44❑ Yes 45 ❑ No 53. Number of bedrooms..............
38 Coal
39 er — Specify �<jr Will there a an el votor? Full..........
54. Number of
46 Yes 7❑ No bathrooms
Partial.......
I hereby certify that the proposed work is authorized by the owner 'of record`
and I have been authorized by the owner to make this applicatitin- as 'his
authorized agent.
SIGNATURE OF AbENT J
ADDRESS --
(NUMBER) (STREET) (CITY)
APPROVED BY TITLE
DATE 19
DEPT. FILE COPY
DEPARTMENT OF BUILDING INSPECTIONS 1 LDI NG �
212 MAIN STREET BUILDING PERMIT
NORTHAMPTON, MA. 01060 VALIDATION
29 — 286 Code #79
DATE October 25, 19 79 PERMIT NO. 619
APPLICANT Samuel Adams ADDRESS 28 Pencasal St. , Florence
(NO.) (STREET) (CONTR'S LICENSE)
NUMBER OF
PERMIT TO Solar -panels STORY Solar heat panels DWELLING UNITS 1
(TYPE OF IMPROVEMENT) NO. (PROPOSED USE)
ZONING T�Q
AT (LOCATION) 28 Peneasal DISTRICT - - -
(NO.) (STREET)
a BETWEEN AND
w (CROSS STREET) (CROSS STREET)
LOT
D SUBDIVISION LOT BLOCK SIZE
m
U
O BUILDING IS TO BE FT. WIDE BY FT. LONG BY FT. IN HEIGHT AND SHALL CONFORM IN CONSTRUCTION
IS
Z TO TYPE USE GROUP BASEMENT WALLS OR FOUNDATION
(TYPE)
F
a ,
O
LL REMARKS:
AREA OR ESTIMATED COST $ 1 ,000 FEEMIT 10.00
VOLUME
(CUBIC/SQUARE FEET)
n
OWNER Samuel & Linda Adams - BUI t D PT.
ADDRESS 2R 'N•nnngnl Si-.rppt,r T+'lnrAnopy May njn6n BY
(Affidavit on reverse side of application to be completed by authorized agent of owner)