29-280 (2) 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.
IV. IDENTIFICATION — To be completed by all applicants
Name Mailing address — Number, street, city, and State ZIP code Tel. No.
Owner or
Lessee
Builder's
L. bv'c= e
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 Re wired Check Plan Review Date Plans By Plans B Notes
q Fee Started y Approved y
BUILDING
PLUMBING
MECHANICAL
ELECTRICAL
OTHER
V1. ADDITIONAL PERMITS REQUIRED OR OTHER JURISDICTION APPROVALS
Permit or Approval I Check Date Number B Permit or Approval I Check Date Number B
PP Obtained y pp 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 gq /
Building Use Group
Permit issued ( { 19
Fire Grading
Building
Permit Fee . �`� Live Loading
Certificate of Occupancy $ Occupancy Load
A ed by:
Drain Tile
Plan Review Fee
TITLE
NOTES and Data — (For department use)
a
CITY OF NORTHAMPTON
OFFICE OF THE INSPECTOR OF BUILDINGS
212 MAIN STREET APPLICATION FOR
NORTHAMPTON, MA. 01060 r� PLAN EXAMINATION AND
< BUILDING PERMIT
IMPORTANT — Applicant to complete all items in sections: 1, 11, 111, IV, and IX. O
AT (LOCATION) 7 3 � e1 / e ZONING/,��
✓../'� C �1 E' � fc' DISTRIC
LOCATION (NO.) (STREET)
OF BETWEEN AND
BUILDING (CROSS STREET) (CROSS STREET)
LOT
SUBDIVISION LOT BLOCK SIZE
Vf
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 9 Residential Nonresidential
2 0 Addition(If residential, enter number 12 r;� One family 18 Ej 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— — — — --3p. 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 ——————— — -i 22 Service station, repair garage
enter number of units in building in 15 ❑ Garage 23 ❑ Hospital, institutional
Part D, 13) ❑
16 Carport 24 El Office, bank, professional
6 ❑ Moving (relocation)
7 F-1 Foundation only 17 F__1 �
Other — Specify 25 ] Public utility
26 C] School, library, other educational
B. OWNERSHIP 27 ❑ Stores, mercantile
8 ® Private (individual, corporation, 28 E] 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................ ® ,C" 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 $
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.
..I .e ma y
E. PRINCIPAL TYPE OF FRAME G. TYPE OF SEWAGE DISPOSAL J. DIMENSIONS
30 C�Masonry (wall bearing) 40 ❑ Public or private company
48. Number of stories................ r/T
31 Wood frame 41 ❑ Private (septic tank, etc.) 49. Total square feet floor area,
all floors, based on exterior
32 ❑ Structural steel dimensions .....................
33 ❑ Reinforced concrete H. TYPE OF WATER SUPPLY
34 F-1 Other — Specify 42 F-1 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 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? 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 s•
authorized agent.
SIGNATURE OF AGENT
ADDRESS _
(NUMBER) (STREET) (CITY)
APPROVED BY TITLE
DATE 19
r
DEPT. PILE COPY
Zp
7-
BUILDING
C= of NORTHAMPTON PERMIT
VALIDATION
NORTHAMPTON2 MA. 29-280
DATE July 19, 19 78 PERMIT NO. 29
APPLICANT Ch- arles Andrus, _ ADDRESS -59 Brookside Cirele
(NO.) (STREET) (CONTR'S LICENSE)
NUMBER OF
PERMIT TO Garage (1_) STORY Two car garage DWELLING UNITS �
(TYPE OF IMPROVEMENT) NO. (PROPOSED USE)
ZONING
AT (LOCATION) 15c3 Brookside Circle DISTRICT
(N0.) (STREET) .
rn BETWEEN AND
'p (CROSS STREET) (CROSS STREET)
LOT
a SUBDIVISION LOT BLOCK SIZE
m
a
p BUILDING IS TO BE 22 FT. WIDE BY FT. LONG BY FT. IN HEIGHT AND SHALL CONFORM IN CONSTRUCTION
m
Z TO TYPE USE GROUP BASEMENT WALLS OR FOUNDATION
(TYPE)
E
0 REMARKS: Construct two car garage (unattached -
AREA OR p PERMIT
AREA 1 nTnn
VOLUME 528 ESTIMATED COST $
(CUBIC/SQUARE FEET)
OWNER Charles AndLrus BUIL
ADDRESS ;? Rronkel fie Cj r�l a N,t"n -- BY
i
(Affidavit on reverse side of application to be completed by authorized agent of owner)