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FRONT YARD
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NOTES
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BOCA FORM APEBP - 669 01969 BUILDING OFFICIALS 8, CODE ADMINISTRATORS INTERNATIONAL, INC.
IV. IDENTIFICATION — To be completed by all applicants
Name Mailing address — .Number, street, city, and State ZIP code Tel. No.
� s �w
Owner or i� s(�
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.
Signs r of ap ant Address Application date
00 NOT WRITE BELOW THIS LINE
V. PLAN REVIEW RECORD — For office use
Plans Review Required Check Plan Review Date Plans B Date Plans B Notes
q Fee Started y Approved y
BUILDING $
PLUMBING $
MECHANICAL $
ELECTRICAL $
OTHER $
VI. ADDITIONAL PERMITS REQUIRED OR OTHER JURISDICTION APPROVALS
Date Permit or Approval Check Obtained Number By Permit or Approval Check Obtta Date in
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
Building Use Group
Permit issued �,J-=�'
Building
Fire Grading
� - �'� f-��
Permit Fee $ �l " Live Loading
Certificate of Occupancy $ Occupancy Load
Approved by:
Drain Tile $
Plan Review Fee $ /
TITL
NOTES and Data — (For department use)
9 �
CITY OF NORTHAMPTON
OFFICE OF THE INSPECTOR OF BUILDINGS
212 MAIN STREET APPLICATION FOR
NORTHAMPTON, MA. 01060 F � PLAN EXAMINATION AND
"�7 BUILDING PERMIT
z
IMPORTANT - Applicant to//complete all items in sections: 1, 11, 111, IV, and IX. O
//p� ZONING
I• AT (LOCATION)��N {L- DISTRICT--
LOCATION (NO.) (STREET)
OF BETWEEN AND
BUILDING (CROSS STREET) (CROSS STREET)
LOT
SUBDIVISION LOT BLOCK SIZE
Vr
il. 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 F__1 Two or more family — Enter 19 ❑ Church, other religious
number of units— — — — -->
3 F__1 Alteration (See 2 above) 20❑ Industrial
14 ❑ Transient hotel, motel, 21 ❑ Parking garage
4 ❑ Repair, replacement or dormitory — Enter number 22 ❑ Service station, repair garage
5 ❑ Wrecking (If multifamily residential, of units ——————— — --�
enter number of units in building in 15 Garage 5 FORCE 9-0— 23 ❑ Hospital, institutional
Part D, 13)
16 Carport 24 E] Office, bank, professional
6 ❑ Moving (relocation)
17❑ Other — Specify 25 ❑ Public utility rt
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,,,,,,,,,,••,... 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 than , enter proposed use.
in the above cost
a. Electrical.....................
b. Plumbing .....................
c. Heating, air conditioning..........
d. Other(elevator, etc.)............ f�
11. TOTAL COST OF IMPROVEMENT $ Qd�
III. SELECTED CHARACTERISTICS OF WILDING - 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............
30❑ Masonry(wall bearing) 40 ❑ Public or private'o p
31 Wood frame 41 El Private (septic tank, etc.) 49. Total square feet n floor area,
®
all floors, based on exterior
32❑ Structural steel dimensions .....
H. TYPE OF WATER SUPPLY
33 F-1 Reinforced concrete f�
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
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? 54. Number of Full..........
46 ❑ Yes 47 ❑ No bathrooms
Partial.......
t
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i IN
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a.
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T f s� _� Y S� �. € Y��" � .y> �' �- "F Y.� � .,'� k $x� � �'•+5'..
r " #
a.
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
ADDRESS
(NUMBER) (STREET) (CITY)
r:
APPROVED BY TITLE
DATE 19
za
DEPT. PILE COPY
_. CITY OF NORTHAMPTON BUILDING <a
NORTHAMPTON, MA, 35-186 PERMIT VALIDATION
DATE July 10, 1978 PERMIT NO.. 271
APPLICANT F-dwan Ma-t;usko, Jr. ADDRESS 17 Graves Ave.
(N0.) (STREET) (CONTR'S LICENSE)
PERMIT TO Garage storage 1 STORY storage NUMBER OF
(_1 DWELLING UNITS
(TYPE OF IMPROVEMENT) NO. (PROPOSED USE)
ZONING
AT (LOCATION) Roman Road DISTRICT S
(N0.) (STREET)
a BETWEEN AND
'o (CROSS STREET) (CROSS STREET)
a
e
SUBDIVISION LOT
LOT BLOCK -SIZE
0 BUILDING IS TO BE FT. WIDE BY FT. LONG BY FT. IN HEIGHT AND SHALL CONFORM IN CONSTRUCTION
O
m
O
Z TO TYPE USE GROUP BASEMENT WALLS OR FOUNDATION
f (TYPE)
IL 0:
REMARKS: Construot garage for storage purposes
AREA OR VOLUME 384 ESTIMATED COST $ 2,000 FFEEMIT , 10.00
(CUBIC/SQUARE FEET) 11
OWNER F,rl. Y) Matu sko, .Tr_
BUILD G D 3
ADDRESS 17 CrrqTT(n,q Ave, N'tan, BY
(Affidavit on reverse side of application to be completed by authorized agent of owner)