35-044 (9) VIII. ZONING PLAN EXAMINERS NOTES
DISTRICT
USE
FRONT YARD
SIDE YARD SIDE YARD
REAR YARD
NOTES
IX. SITE OR PLOT PLAN — For Applicant Use
177 17
+�
o + r�r
p v g
�"4 1�i E a.-'ar h7'r ms}r+(#t 9 e.'a m!'r t Y T m°{4".°,q^.rr.,y e a w 1 m m t 4 a 6 t:a€C�.}mr-.��a6:s f?7,'"t+t'P".'o}i r":."-"f}^g�#r�".m,--�t t�tI-m s f1 t F r P a+9{a er+i#Y 4 r m o-m-+aa'-�s.�;z'+���-m^--w----'.§%z b k�r 9"r r tih t v t.#�m r m..1 1 T a I{a#!--."`I d+§?k!���s t s i p'g p t g p�mr fI x,'+�i$k kr#,.-_"-..."Q:�rq,a_6-�;:.+^€�+x i--a.�,Y a&r Y���jm r,p+ir P'.-a'°��r+;r1"'d_d r t.-^"k s`f^.-"t-YRts%".°-._-.:^-s..-"m.`�r k�r 3'r°I�-".±4 Y'��[(..-'�i»Y;#§•'''-}ti y�L 3 t¢+e�ma.`t
y.,b}.#5x-.'-.-`y,b_•g�aa c f'"?cf-.;-+',..m ti.a 7-�`'p i-m't m x"-.{c rfa I��i P+E s_ami r xp r,"r-±i.l{�s e�-"}�{
..
} g
1 .
i yg.Ja S m�
a-r f r P
g1
1b % 1
$r 8
3
g i +t
At -T -
sT k
a
�11-4 k
5+ .
. ttlf± fT a i .{l.
11 715 r 4.
�Fl.t
gir f 444"
4 IT,3 g» r 4- - {
r 17-4
a ?- 7 i
C r= ri p# IT' gfP.
4
, 'a
w; + 4k -
^ ^ 1+ b h§
r1 d H-H
11-4 p-y Ht ia
. b ,.3 m 5 1 tf
a 444— - ;o-i +
g:}M� g"
i
r}r§ b<1it'5f4;.6'f x-m
-,-
._,.
..-.,�s..
1.,aaa
b.
y.6
..`:
...
..��.
-
...
e...
"
,.
„4 d-a-
t 4-6
P -? --§. d €t @ h#'
ky{l -b 5 .'Y i : P T 1 ±f gd, -1yi .. L } Fpi... big-:--% "€E
k"3 P
r s�. e.m+ :.4.. r r� r••- sy' '�j'.
i
e < .g-_P" P-f y+-4. =a .F'a"
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 61� �D 'C' ter � 19!�:b = ti
O fUG
Lessee �( �J
2. OeJ< 2T' 1��OJL-� /y /U� 70 LBcenserNo.
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
ar�iu c� �L 7-,ZP-
DO 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
VI. ADDITIONAL PERMITS REQUIRED OR OTHER JURISDICTION APPROVALS
Date Date
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 333
Building Use Group
Permit issued %&L4 19�
Building
Fire Grading
Co Permit Fee $ CCoo Live Loading
Certificate of Occupancy $ Occupancy Load
AD Droved by:
Drain Tile
Plan Review Fee
TITLE
NOTES and Data — (For department use)
f
t�
a w
CITY OF NORTHAMPTON
OFFICE OF THE INSPECTOR OF BUILDINGS
212 MAIN STREET APPLICATION FOR
NORTHAMPTON, MA. 01060 PLAN EXAMINATION AND
BUILDING PERMIT
z
IMPORTANT — Applicant to complete all items in sections: 1, 11, 111, IV, and IX. �''> O
ZONING
I• AT (LOCATION) `Z DISTRICT: �
LOCATION (NO.) (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 Residential Nonresidential
2 El Addition(I residential, enter number
f 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
3 ❑ Alteration (See 2 above)
number of units- - - - --)- 20 ❑ Industrial
14 ❑ Transient hotel, motel, 21 ❑ Parking garage
4 ❑ Repair, replacement or dormitory - Enter number
5 F-1 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 ❑ Other - SpeciJy 25 ❑ Public utility
7 ❑ Foundation only
26 ❑ School, library, other educational
B. OWNERSHIP � 27 ❑ Stores, mercantile
8 Private (individual, corporation, 28 ❑ 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,,,•,•,,•••,,... L 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
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 Al 49
30❑ Masonry (wall bearing) 40 �� Public or private company 48. Number of stories.......area, ...
31 Wood frame 41,XPrivate (septic tank, etc.) . Total square feet floor area,
all floors, based on exterior
32M 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 W re be central air 52. Outdoors........................
36 Oil conditionin
L. RESIDENTIAL BUILDINGS ONLY
37 Electricity 44 ❑ Yes 53. Number of bedrooms........
38 ❑ Coal
39❑ Other - Specify Will there a an elevator? Full..........
54. Number of
Yes 47❑ No bathrooms
Partial.......
hereby certify-that the proposed work is authorised 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 1g
41<7 04Z __ DEPT. FILE COPY
ZO
BUILDING �a
PERM *��[
I VALIDATION
cJ CTL
TE 19!✓ PERMIT
APPLICANT ADDRESS
(NO.) TREET) (CONTR'S LICENSE)
.,. ; �
NUMBER OF
PERMIT TO (,) STORY DWELLING UNITS
(TYPE OF IMPROVEMENT) NO. (PROPOSED USE)
ZONING t`�
AT (LOCATION) DISTRICT—v
_075.) (STREET)
a BETWEEN. AND
�p (CROSS STREET) (CROSS STREET)
w
LOT
n SUBOW ISION 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
m
O USE GROUP BASEMENT WALLS OR FOU ATION
Z TO TYPE
� .,� (TYPE)
O
LL REMARKS'
PERMIT
AREA OR
VOLUME ESTIMATED COST $ FEE
(CUSI QUARE FEET) --_
D
OWNER BUI I T
BY
ADDRESS
(Affidavit on reverse side of application to be completed by authorized agent of owner)