1 VIII. ZONING PLAN EXAMINERS NOTES
DISTRICT
USE
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NOTES
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BOCA FORM APEBP — 669 01969 BUILDING OFFICIALS IN 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 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.
SigrrAAre of applicant Address Application date
6" 7,q
00 NOT WRITE BELOW THIS LINE
V. PLAN REVIEW RECORD — For office use
Plan Review Date Plans Date Plans
Plans Review Required Check Fee Started BY Approved BY Notes
BUILDING
PLUMBING
MECHANICAL
ELECTRICAL
OTHER
VI. ADDITIONAL PERMITS REQUIRED OR OTHER JURISDICTION APPROVALS
Permit or Approval Check Date Number B Permit or Approval Check Dote Number B
pP Obtained Y pp Obtained Y
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 N
Building w Use Group
Permit issued D� �19 ,]�7Cf-- Fire Grading
Building
Permit Fee $ ®q 40 Live Loading
Occupancy Load
Certificate of Occupancy
Approved by:
Drain Tile
i
Plan Review Fee
TITLE
NOTES and Data — (For department use)
C � ,
CITY OF NORTHAMPTON
OFFICE OF THE INSPECTOR OF BUILDINGS �'�(, =I=7
212 MAIN STREET APPLICATION FOR
NORTHAMPTON, MA. 01060 PLAN EXAMINATION AND
BUILDING PERMIT
z
IMPORTANT — Applicant to complete all items in sections: I, 11, III, IV, and IX. O
I• AT (LOCATION) 1`1�' \&/C �( f if\u I°%�� )�-1. D�STR CT `
LOCATION (NO') (STREET)
OF BETWEEN AND
BUILDING (CROSS STREET) (CROSS STREET)
LOT
SUBDIVISION LOT BLOCK SIZE
H
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 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 ❑ Alteration (See 2 above)
14 ❑ Transient hotel, motel, 21 ❑ Parking garage
4 ❑ Repair, replacement or dormitory — Enter number
units ——————— — -� 22 ❑ Service station, repair garage
5 F-1 o Wrecking (IJ multifamily residential, f
enter number of units in building in 15,P�J,Garage 23 ❑ Hospital, institutional
Part D, 13)
16 Car -� 24❑ Office, bank, professional
6 ❑ Moving (relocation) ❑ `n
1717_,K Othee art r — SpeciJy ❑25 Public utiliT
Y
7 ❑ Foundation only
26 ❑ School, library, other educational
B. OWNERSHIP 27 ❑ Stores, mercantile
8 1 Private (individual, corporation, 28 ❑ Tanks, towers
JK,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.).............
11. TOTAL COST OF IMPROVEMENT $ l
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 ,
48. Number of stories................ 1 J'`
30❑Masonry (wall bearing) 4ublic or private company
49. Total square feet of floor area, .y�/i(.:"/ ��"•• l —
31�Wood frame 41 Private (septic tank, etc.) l
all floors, based on exterior
32❑ Structural steel dimensions .....................
33 ❑ Reinforced concrete H. T PE OF 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 �"7
51. Enclosed .............G._._.....
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
3910 Other — Specify4 , Will there be an elevator? 54. Number of Full..........
46 ❑ Yes 47 2/ 20 bathrooms Partial........
hereby certify that the proposed work is au#ha ized by the owner of record
and 1 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
DEPART OF BUILDING INSPECTIONS no
. _.. � STFMT
01060 ry BUILDING as
Code 7" PERMIT VALIDATION
35-37 �7�Z
DATE June 6. 19 L PERMIT NO. 2-45
APPLICANT Joseph Wernik ADDRESS 198 Weat Farms Rd•
(NO.) (STREET) (CONTR'S LICENSE)
NUMBER OF
PERMIT TO Ggj!S re®7 May (-�-) STORY gAPW ���BWAy DWELLING UNITS t
(TYPE F IMPROVEMENT) NO. (PROPOSED USE)
ZONING CID
AT (LOCATION) 198 8 West Dams Road DISTRICT MAL
(NO.) (STREET)
m BETWEEN AND
m (CROSS STREET) (CROSS STREET)
rn
LOT
a SUBDIVISION LOT BLOCK SIZE
¢ Garage 24 2
O O ByP1 PP IS TO BE FT. WIDE BY FT. LONG BY FT. IN HEIGHT AND SHALL CONFORM IN CONSTRUCTION
m Breezeway 18 12
2 TO TYPE USE GROUP BASEMENT WALLS OR FOUNDATION
(TYPE)
I
O:
O
LL REMARKS: Open breezek= & garage
AREA OR ESTIMATED COST $ / .0w FEEMIT $ 21,00
VOLUME
(CUBIC/SQUARE FEET)
OWNER joacp$ RC stlsaii WeMi BOIL NG PT.
ADDRESS 198 Went ra—M RoaA Nlti=- - BY
(Affidavit on reverse side of application to be completed by authorized agent of owner)