29-280 VIII. ZONING PLAN EXAMINERS NOTES
DISTRICT /1
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 CI969 BUILDING OFFICIALS & CODE ADMINISTRATORS INTERNATIONAL, INC.
IfNQF,NTI FI CATION — To be completed by all applicants
Name Mailing address — Number, street, city, and State ZIP code Tel. No.
Owner or
Lessee
Bui Ider'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
00 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 $
V1. ADDITIONAL PERMITS REQUIRED OR OTHER JURISDICTION APPROVALS
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 S
Building Use Group
Permit issuedx,lZ���r77— 19
Building / Fire Grading
Permit Fee I .� t � � Live Loading
Certificate of Occupancy $ Occupancy Load
Approved by:
Drain Tile $
Plan Review Fee $
TITL
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
,�q BUILDING PERMIT
IMPORTANT — Applicant to complete all items in sections: 1, 11, 111, IV, and IX. o
ZONING PA
I• AT (LOCATION) DISTRICT
LOCATION IN 0.) (STREET)
OF BETWEEN AND
BUILDING (CROSS STREET) (CROSS STREET)
LOT
SUBDIVISION LOT BLOCK SIZE
CA
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 Re id ti al Nonresidential
2�Addition(IJ residential, enter number 12 One family 18 ❑ Amusement, recreational
°—C 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 C� Parking garage
4 F-1 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 E:] Hospital, institutional
Part D, 13) ❑
16 Carport 24 E] Office, bank, professional
6 ❑ Moving (relocation)
7 ❑ Foundation only 17� Other — Specify 25 ❑ Public utility
i/ 26 ❑ School, library, other educational
B. OWNERSHIP 27 ❑ Stores, mercantile
❑
8 Private (individual, corporation, ]/ 2
28 Tanks, towers
nonprofit institution, etc.) AZ 4 r / 2— 29 E:] 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$ V 0
III. SELECTED CHARACTERISTICS OF B ILDING — 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) 40XPublic or private company 48• Number of stories................
31 F-1 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. TYRE OF WATER SUPPLY
34 ❑ Other — Specify 42 ublic 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........................
36 ❑ Oil conditioning? L. RESIDENTIAL BUILDINGS ONLY
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'
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 }9
DEPARTMENT OF BU11DING INSPECTIONS z Q DEPT. FILE COPY
212 MAIN STREXT BUILDING 0a
NORTHAMPTON, MA, 01060 PERMIT
VALIDATION
29 • 280
DATE June 18, 19 80 PERMIT NO. 315
APPLICANT Charles A Andrus ADDRESS 359 Brookside Circle
(NO.) (STREET) (CONTR'S LICENSE)
NUMBER OF
PERMIT TO I oAl (_) STORY �3�8IMMIing 1lAA� -DWELLING UNITS
(TY E OF IMPRO EMENT) NO. (PRO S D USE)
ZONING A
AT (LOCATION) _ 359 Brookside Circle DISTRICT
(NO.) (STREET)
a. .BETWEEN AND
10 (CROSS STREET) (CROSS STREET)
LOT
d SUBDIVISION LOT BLOCK SIZE
m
a
v BUILDING IS TO BE FT. WIDE BY FT. LONG BY FT. IN HEIGHT AND SHALL CONFORM IN CONSTRUCTION
O
10
O USE GROUP BASEMENT WALLS OR FOUNDATION
Z TO TYPE (TYPE)
f
m
0 REMARKS: InStall ineround Pool 16' X 32' -
AREA OR n PERMIT �Q 00
VOLUME ESTIMATED COST FEE
(CUBIC/SQUARE FEET)
OWNER CharleB A- Andrus BUIL NG PT.
ADDRESS 359 Brookside Circles Florence. Ha- 01060 BY
(Affidavit on reverse side of application to be completed by auto zed agent of owner)