25-062 (2) VIII. ZONING PLAN EXAMINERS NOTES
DISTRICT
USE
FRONT YARD
SIDE YARD SIDE YARD
REAR YARD
NOTES
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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 address — plumber, street, city, and State ZIP code T�e_I. No.
Owner or �` ' l/
Lessee `'I L9
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 ppli ant Address Application date
JDO 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
Building Use Group
Permit issued I��.G 19
Building ,ry (� Fire Grading
Permit Fee $ Live Loading
Certificate of Occupancy Occupancy Load
Appr by:
Drain Tile $
Plan Review Fee
TITLE
NOTES and Data — (For department use) M
4j
nn^^
v� ..
i
CITY OF NORTHAMPTON
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, Ill, IV, and IX. / o
/ ZONING
• AT (LOCATION) DISTRICT`
LOCATION (N0.) I (STREET) � 1
OF BETWEEN V x►�— AND f L`LS h1 V1 J
BUILDING CROSS STREET) (CROSS STREET)
LOT
SUBDIVISION LOT BLOCK SIZE
N
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
IM
1 ❑ New building Resid ntial 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 ❑ Alteration (See 2 above) 20 ❑ Industrial
14 ❑ Transient hotel, motel, 21 ❑ Parking garage
4 dRepair, 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) ❑
16 Carport 24❑ Office, bank, professional
6 ❑ Moving (relocation)
7 ❑ Foundation only 17❑ Other — Specify 25 ❑ Public utility
26 ❑ School, library, other educational
B. OWNE HIP 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 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 $ to
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 r asonry (wall bearing) 40 Public or private company 48• Number of stories.............
31 L Wood frame 41 Private (septic tank, etc.) 49. Total square feet Floor area,
all floors, based on exterior
32 ❑ Structural steel dimensions ..................... lal�
33 ❑ Reinforced concrete H. TYPE WATER SUPPLY
34F-1 Other — Specify 42 blic or private company 50. Total land area, sq. ft. ...........
43 ❑ Private (well, cistern) K. NUMBER OF OFF-STREET
PARKING SPACES ?
F. PRINC AL TYPE OF HEATING FUEL I. TYPE OF MECHANICAL 51. Enclosed .......................
35 Gas 52. Outdoors........................
Will there be central air
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 elevatorVN Full.......... t
54. Number of
46 ❑ Yes 47 o 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 ';c3s-hi s.l
authorized agent.
SIGNATURE OF� SAGENT j
ADDRESS
UMBER) (STREET) (CITY)
APPROVED BY T1tLE.
DATE 19
.. .'.-. ._. a .-, ;....
f
DEPARTMENT OF BUILDING INSPECTIONS DEPT. FILE COPY
Zo
212,MAIN'STREET 'Oa
NORTHAMPTON MA. 01060 BUILDING Q IL
25-PP- 62 CODE 7f77 PERMIT VALIDATION
DATE H., Is- 19 $Q PERMIT NO. 26.E
APPLICANT P, 4 l 4 n Al ape ADDRESS III-t).ld Ferr Rd-
(NO.) (57REE T) (CONTR'S LICENSE)
NUMBER OF
PERMIT TO Q_) STORY R4104dornc DWELLING UNITS �
PROVEMENT) NO. (PROPOSED USE)
ZONING
AT (LOCATION)
e
FrT3L Road DISTRICT A
(NO.) (STREET)
a BETWEEN AND
'o (CROSS STREET) (CROS$, STRE£T)
LOT
LL SUBDIVISION LOT BLOCK SIZE
m
V
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
(TYPE)
LL REMARKS: MpA_ ,},jAQW1, Ij1$t$11 5 skylights; l dnrmar (smA ), install one 21&ss door$
misc. renovations.
AREA OR VOLUME ESTIMATED COST $ FEE MIT $ 10.00
(CUBIC/SQUARE FEET) 4
l
OWNER Philip Al$re BU F T
ADDRESS 111 01A Ferry Rd_F N'ton. e
(Affidavit on reverse side of application to be completed by authorized agent of owner)
Poo I