25-054 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
T Name Mailing address — Number, street, city, and State ZIP code Tel. No.
� • r
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.
Signature of applicant Address Application date
a� 7� 7 e
00 NOT WRITE BELOW THIS LINE
V. PLANT REVIEW RECORD — For office use
Plans Review Re uired Check Plan Review Date Plans B Date Plans B Notes
9 Fee Started y Approved y
BUILDING
PLUMBING
MECHANICAL
ELECTRICAL
OTHER
V1. ADDITIONAL PERMITS REQUIRED OR OTHER JURISDICTION APPROVALS
Permit or Approval Check Date Number Ei Permit or Approval Check Date Number B
pp Obtained y pp Obtained 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 C �2 r7 19�
Building // Fire Grading
Permit Fee $ A-1, Z�Q Live Loading
Occupancy Load
Certificate of Occupancy
d by:
Drain Tile $ •
IOWA Plan Review Fee $ d
TITLE
NOTES and Data — (For department use) x
- * f CITY OF NORTHAMPTON
OFFICE OF THE INSPECTOR OF BUILDINGS
212 MAIN STREET APPLICATION FOR
NORTHAMPTON, MA. 01060 LAN EXAMINATION AND
C:1S8z:)-4r BUILDING PERMIT
IMPORTANT — Applicant to complete all items in sections: 1, 11, 111, IV, and IX. O
ZONING
I• AT (LOCATION) `� .%f � ttr,�.p �[�._..f / C' -7 DISTRICTS �+
LOCATION (N0.) (STREET)
OF BETWEEN AND
BUILDING (CROSS STREET) (CROSS STREET)
LOT
SUBDIVISION LOT BLOCK SIZE
V1
II. TYPE AND COST OF BUILDING — All applicants complete Pcrts A — D
A. TYPE OF IMPROVEMENT D. PROPOSED USE - F'or"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- - - - ->
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 23 ❑ Hospital, institutional
Part D, 13) ❑
16 Carport 24❑ Office, bank, professional
6 ❑ Moving (relocation)
7 F__] Foundation only 17 F-1 Other - SpeciJy 25 ❑ Public utility
26 ❑ School, library, other educational
_b F
B. OWNERSHIP �'r aM G'rt 27 ❑ Stores, mercantile
8 ❑ Private (individual, corporation, f It 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,,,,,,•,•....... 0 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 is e
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 ❑ Wood frame 41 ❑ Private (septic tank, etc.) 49. Total square feet of floor area,
all floors, based on exterior
32❑ Structural steel dimensions .....................
33 ❑ Reinforced concrete H. TYPE OF WATER SUPPLY
34 F-1 Other - Specify 42 F-1 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.......
hereby certify that the proposed work is authorized by the owner of record
and I have been authorized by the owner to make this applicatiou .as, his
authorized agent.
SIGNATURE O AGENT;. c
ADDRESS
(NUMBER) (STREET) (CITY)
APPROVED BY TITLE
DATE 19
C J
I-
Z❑
__- XTIONS BUILDING
NpR�, NSTREET, o� PERMIT VALIDATION
r1 25BD - 54
DATE Marcel 27,,19 2 PERMIT NO. 92
APPLICANT Jobe 4 .8v]aynki ADDRESS J�76 �.-M8-In � 3t•�- in 0.
INO.) (STREET) (CONTR'S LICENSE)
NUMBER OF
PERMIT TO TDmrolition (_) STORY BLM DWELLING UNITS
(TYPE OF IMPROVEMENT) NO. (PROPOSED USE)
AT (LOCATION) RiverbAink Rnad ZONING
DISTRICT sr.
(NO.) (STREET)
a BETWEEN AND
a_
(CROSS STREET) - (CROSS STREET)
LOT
2 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
O
Z TO TYPE USE GROUP BASEMENT WALLS OR FOUNDATION
I (TYPE)
K
o REMARKS: De=l.j.ti.al of haLTyn 151 0 Z JWI - 0„ .
AREA OR s VOLUME ESTIMATED COST $ 900.00 FEEMIT .�Q•OQ
(CUBIC/SQUARE FEET)
OWNER •7@b Arinifl owski BU
ADDRESS 126 No. NMIa St. BYI
(Affidavit on reverse side of application to be completed by authorized agent of owner)