29-281 (2) VIII. ZONING PLAN EXAMINERS NOTES
DISTRICT
USE
FRONT YARD
SIDE YARD - SIDE YARD
REAR YARD G N_
NOTES
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BOCA FORM APEBP — 669 C1969 BUILDING OFFICIALS & CODE ADMINISTRATORS INTERNATIONAL, INC.
IV. IDENTIFICATION — To be completed by alP'5Pplicants
Name Mailing address — Number, street, city, and State ZIP code Tel. No.
Owner or
Lessee t
Builder's
2.
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.
Signature of applicant Address Application date
f (
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
9 Fee Started y Approved y
BUILDING
PLUMBING
MECHANICAL
ELECTRICAL
OTHER is
VI. ADDITIONAL PERMITS REQUIRED OR OTHER JURISDICTION APPROVALS
Permit or Approval Check Date Number B Permit or Approval Ch Date Number B
pp Obtained y pp rova Check Obtained 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
Permit Fee $ Live Loading
Occupancy Load
Certificate of Occupancy
Approved by:
Drain Tile
Plan Review Fee
T I T-Lf
NOTES and Data — (For department use)
r
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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: I, IA, lll, IV, and IX. O
ZONING
I• AT (LOCATION) NO T:..T'._-t'j--�-+�-r_-C'L.� DISTRICT y�.
LOCATION / REET)
OF BETWEEN AND
BUILDING (CROSS STREET) (CROSS STREET)
LOT
SUBDIVISION LOT BLOCK SIZE
t/1
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
—f
1 New building Residential 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
t
l
t
t h
i
Transenoe , 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) •_
6 ❑ Moving (relocation) 16 ❑ Carport 24❑ Office, bank, professional
17 Other - Specify 25 ❑ Public utility
7 ❑ Foundation only 26 ❑ School, library, other educational
B. OWNERSHIP 27 ❑ Stores, mercantile
` 28 ❑ Tanks, towers
8 � Private (individual, corporation, Specify
Other - S
nonprofit institution, etc.) 29 ❑ p fy
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
school, secondary school, college, parochial school, parking garage for,
10. Cost of improvement,,,,,,,,,,,,,,,, �., . Y 9 P P 9 9 9
department store, rental office building, office building of 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. Tl(PE OF SEWAGE DISPOSAL J. DIMENSIONS
30❑ Masonry(wall bearing) 40 Public or private company 48• Number of stories................
31 fWood 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 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❑ Gas Will there be central air 52. Outdoors........................
conditioning?
36,F] oil L. RESIDENTIAL BUILDINGS ONLY
370 Electricity 44 ❑ Yes 45 No 53. Number of bedrooms..............
38 ❑ Coal
39❑ Other - Specify Will there be an elevator?' Full..........
54. Number of
46 ❑ Yes 47 � 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 application as his
authorized agent.
SIGNATURE OF AGENT
ADDRESS -
(NUMBER) (STREET) (CITY)
APPROVED BY TITLE
DATE 19
DEPT. FILE COPY
BUILDING fa
PERMIT
VALIDATION
DATE ✓77719 PE Np.
APPLICANT ' ADDRESS n
(N (STREET) CONT R'S L(CENSE)
( /
' NUMBER OF
PERMIT TO (�) STORY ✓' '' DWELLING UNITS
(TYPE OF IMPROVEMENT) 0. ( 0 SEp USE)
�' ZONING —
AT (LOCATION) DISTRICT
( O.J (STREET)
a BETWEEN AND
'O (CROSS STREET) (CROSS STREET)
a_
IL LOT
m SUBDIVISION LOT BLOCK SIZE
a
U
O BUILDING IS TO BE FT. WIDE BY FT. LONG BY FT. IN HEIGHT AND SHALL CONFORM IN CONSTRUCTION
O
Z TO TYPE USE GROUP BASEMENT WALLS OR FOUNDATION
f
� .. .... (TYPE)
O
a REMARKS: 1121
-�
VOLUME ESTIMATED COST $ 7 '�i FEE MIT
{CUBIC/SQUARE FEET) —7
s�
OWNER
BUILDING P
AODRE BY
(Affidavit on reverse side of application to be completed by authorized agent of owner)
on will