29-268 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
Lessee
Builder's
2.
S 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.
Signaturerpf applican Address j Application date
Gt -7f�c'C/f �/
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
9 Fee Started y Approved y
BUILDING
PLUMBING
MECHANICAL
ELECTRICAL
OTHER
VI. ADDITIONAL PERMITS REQUIRED OR OTHER JURISDICTION APPROVALS
Permit or Approval Check Date Number B Permit or Approval Check Dare Number By
pp Obtained y pp Obtained
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 T Use Group
Permit issued 19/
Building
Fire Grading
/"�, �
Permit Fee $ C Live Loading
Occupancy Load
Certificate of Occupancy
A rove by: ^ '
Drain Tile $
Plan Review Fee
TITLE
NOTES and Data — (For department use)
CITY OF NORTHAMPTON
OFFICE OF THE INSPECTOR OF BUILDINGS
212 MAIN STREET APPLICATION FOR
NORTHAMPTON, MA. 01060�( . `)iG PLAN EXAMINATION AND
c � BUILDING PERMIT
IMPORTANT — Applicant to complete all items in sections. 1, 11, III, IV, and IX. O
ZONING
I• AT (LOCATION) � tj 7 � DISTRIC
LOCATION 0.) (STREET)
OF BETWEEN AND
BUILDING (CROSS STREET) (CROSS STREET)
LOT
SUBDIVISION LOT BLOCK SIZE
Vr
II. TYPE AND COST OF BUILDING — All applicants complete Parts A — D
A. TYPE OF IMPROVEMENT D. PROPOSED USE — For"Wrecking" most recent use im
M
1 ❑ New building Resident' I Nonresidential
2 ❑ Addition(If residential, enter number 12 One family 18 ❑ Amusement, recreational
of new housing units added, if any, 13 F-1 Two or more family — Enter 19 ❑ Church, other religious
in Part D, 13) number of units— — — — ->
20 ❑ Industrial
3 F-1 Alteration (See 2 above) 14 l
l
h
i
Transent hotel, mote ,
❑ 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)
17 F-1 Other — Specify 25 ❑ Public utility
7 E] Foundation only
itijs75, f/� �� 26 ❑ School, library, other educational
B. OWNERSHIP / 27 ❑ Stores, mercantile
8 ❑ Private (individual, corporation, � 28 ❑ Tanks, towers
nonprofit institution, etc.) �4/0/Ll/1I� rte• 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.)............
11. TOTAL COST OF IMPROVEMENT 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
30❑Masonry (wall bearing) 40 ❑ Public or private company 48• Number of stories................
31 F-1 Wood frame 41 ❑ Private (septic tank, etc.) 49. Total feet floor area,
all fl000rsrs,, 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 r❑ 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 4_
ADDRESS
(NUMBER) (STREET) (CITY)
APPROVED BY TITLE
DATE 19
Z
DEPT: FILE COPY
D
CITY OF NOR'T'HAMPTON BUILDING a
NORTHAMPTON, MA.
29-268 PERMIT VALIDATION
DATE July 21 , lg_ 78 PERMIT N0. 2()4
APPLICANT T'rnnk F Mirl y'n- Ir- ADDRESS 44 Tnnpr a,la - Fla_
(ND.) (STREET) (CONTR'S LICENSE)
NUMBER OF
PERMIT TO Chirmey inata l i On (1_) STORY Wood stave —DWELLING UNITS
(TYPE OF IMPROVEMENT) NO. (PROPOSED USE)
�)(
ZONING TT�Q
AT (LOCATION) 44 TPo gad ex Dr. DISTRICT
(NO.) (STREET)
a BETWEEN AND
�o (CROSS STREET) (CROSS STREET)
LOT
o SUBDIVISION LOT BLOCK SIZE
m
a
O
BUILDING IS TO BE FT. WIDE BY FT. LONG BY FT. IN HEIGHT AND SHALL CONFORM IN CONSTRUCTION
m
O
Z TO TYPE USE GROUP BASEMENT WALLS OR FOUNDATION
� (TYPE)
B:
IL REMARKS:. Tnatallatinn of nhimney for Load 4t sre -
AREA OR ESTIMATED COST . P E��P 10.00
VOLUME
(CUBIC/SQUARE FEET)
R.
OWNER Frank F Midj2�rrt, Jr T.
ADDRESS 44 Long l ew I , Fl arence - B
(Affidavit on reverse side of application to be completed by authorize agent of owner)