35-165 (2) I
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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 aadddress — Number, street, city, and State ZIP code Tel. No.
wne
Or or
Lessee
/ Builder's
L.
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.
li E a p 4U L-- Addresri7 P !z APPli�cartion date ce
(' o
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 Is
OTHER Is
V1. 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 '7
Building Use Group
Permit issued 19 _
Building Fire Grading
Permit Fee ,� �./ Live Loading
Certificate of Occupancy $ Occupancy Load
Approved by:
Drain Tile $
Plan Review Fee
(� TITLE
NOTES and Data — (For department use)
CITY OF NORTHAMPTON
"Oil OFFICE OF THE INSPECTOR OF BUILDINGS
212 MAIN STREET APPLICATION FOR
NORTHAMPTON, MA. 01060 PLAN EXAMINATION AND
BUILDING PERMIT
IMPORTANT — Applicant to complete all items in sections: 1, 11, 111, IV, and IX. O
�//j ZONING
I• AT (LOCATION) eri� �� /� DISTRICTC�
LOCATION (NO.) REET)
0 F 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 9 Resi ential 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 F1 Two or more family — Enter 19 ❑ Church, other religious
number of units— — — — --> 20 ❑ Industrial
3AITeration (See 2 above) 14 Transient hotel, motel,
❑ 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)
6 F__1 Moving (relocation) 16 ❑ Carport 24❑ Office, bank, professional
7 F-1 Foundation only 17❑ Other — SpeciJy 25 E] Public utility
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
q0 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 a1
a. Electrical..................... /00
b• Plumbing .....................
C. Hearing, air conditioning..........
O0 osl
d. Other (elevator, etc.)............ e�
4�yr
11. TOTAL COST OF IMPROVEMENT $ 3Ua
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) 401Public or private company 48• Number of stories..............
31 Wood frame 41 Private (septic tank, etc.) 49. Total square feet of floor area,
all floors, based o ex ri r
32 ❑ Structural steel dimensions ....`� G•
33❑ Reinforced concrete H. TYPE OF WATER SUPPLY
34 F-1 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 ........777777777=..
F. PRINCIPAL TYPE OF HEATING FUEL I. TYPE OF MECHANICAL .r�
35 Gas Will there be central air 52. Outdoors...............
36 Oil conditioning?
L. RESIDENTIAL BUILDINGS 0 LY
3 Electricity 44 ❑ Yes 45 �j 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 Us
authorized agent.
SIGNATURE OF AGENT
ADDRESS-
(NUMBER) (STREET) (CITY)
APPROVED BY TITLE
DATE 19
r: -
DEPT. FILE COPY
DEPARTMENT OF BUILDING INSPECTIONS �D
212 MAIN STREET R' Oa
NORTHAMPTON t MA. 01060 B
PERMIT U'LD DING a
VALIDATION
35 • 165 CODE #79,
DATE May 29, 19_An PERMIT NO. 227
APPLICANT lV(nrt i r T� Noaska ADDRESS R'I 7�Ry anf Rog(1
(N0.) (STREET) (CONT R'S LICENSE)
NUMBER OF
PERMIT TO ( ) STORY ghGA doraler DWELLING UNITS
( P ENT) N0. (PROPOSED USE) ,
ZONING
AT (LOCATION) DISTRICT SB
(N0.) (STREET)
a BETWEEN AND
v (CROSS STREET) (CROSS STREET)
a
LOT
IL SUBDIVISION LOT BLOCK SIZE
m
U
O BUILDING IS TO BE 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)
I
B:
O
I- REMARKS:
AREA OR PERMIT
VOLUME ESTIMATED COST FEE
(CUBIC/SQUARE FEET)
OWNER BU IN T.
ADDRESS d, BY
(Affidavit on reverse side of application to be completed by authorized agent of owner)