02-021 (2) VIII. ZONING PLAN EXAMINERS NOTES
DISTRICT
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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 address — iVurnbcr, street, city, and State ZIP code Tel. No.
1.
Owner or
t I ws 967 of oho 686-0 7
Lessee
Builder's
`L. � ASM Waigem i ra L.D License No.
Contractor
10 G
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.
re of applicant Address Application date
l
00 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 Obtai ed 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 19 '
Building Fire Grading
Permit Fee $ Lf
�— Live Loading
Certificate of Occupancy $ Occupancy Load
Approved by:
Drain Tile $
Plan Review Fee
l TITLE
NOTES and Data — (For department use)
CITY OF NORTHAMPTON
MASSACHUSETTS
OFFICE OF THE INSPECTOR OF BUILDINGS
APPLICATION FOR
PLAN EXAMINATION AND
BUILDING PERMIT
IMPORTANT — Applicant to cco�o/m�plle��t,��e all items in sections: 1, 11, 111, IV-, and IX. O
I• AT (LOCATION) �VIL►r ri`04S a0,4 i I OMAM �t(�IQ ZONING
DISTRICT 12 rz
LOCATION / I� (STREET)
OF BETWEEN •/ AND
BUILDING (CROSS STREET) (CROSS STREET)
LOT
SUBDIVISION LOT BLOCK SIZE_�G����i�
N
II. TYPE AND COST OF BUILDING — All applicants complete Parts A — D
A. TY E F IMPROVEMENT D. PROPOSED USE — For"Wrecking" most recent use m
M
1 New building Resideplial Nonresidential
2 Addition(If residential, enter number 12 One family 18 ❑ Amusement, recreational
of new bousing units added, if any,
in Part D, 13) 13 ❑ Two or more family — Enter 19 ❑ Church, other religious
number of units— — — — --> 20 ❑ Industrial
3 Alteration (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) 16 ❑ Carport 24 ❑ Office, bank, professional
6 ❑ Moving (relocation)
7 ❑ Foundation only 17 ❑ Other — Specify 25 ❑ Public utility
26 ❑ School, library, other educational
B. OWN SHIP 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•,,••,,,,•,••,•• i./��J 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$
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. TYP����E,,,,,, OF SEWAGE DISPOSAL J. DIMENSIONS
30 asonry (wall bearing) 40 ublic or private company 48. Number of stories...............
31 Wood frame 41 Private (septic Tank, etc.) 49. Total square feet of floor area, PyCq
all floors, based on exterior o,
32❑ Structural steel dimensions .....................
33 ❑ Reinforced concrete H. TYPE OF WATER SUPPLY
34 ❑ Other — Specify 42 ❑ ublic or private company 50. Total land area, sq. ft. ........... A
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 ❑ it 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.......... 2
54. Number of
46 ❑ Yes 47 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 his
authorized agent.
SIGNATURE OF AGENt
ADDRESS
(NUMBER) (STREET) (CITY)
1 .
APPROVED BY TITLE
DATE 19
DEPT: FILE COPY
CITY OF AT�RTH�NlPTON
0 ;�-094IJILDING is
NORTUMMN9 rte.. 01 06" PERMIT
2_3 VALIDATION
DATE May 15• 19 78 NO. 1710
APPLICANT Patri nk Gngginh ADDRESS C 6 F nren(1P�O�d
N0. (STREET) (CONTR'S LICENSE)
NUMBER OF
PERMIT TO New Residence (2_) STORY Residence DWELLING UNITS 1
(TYPE OF IMPROVEMENT) NO. (PROPOSED USE)
ZONING RR
AT (LOCATION) DISTRICT
IN (STREET)
an BETWEEN AND
(CROSS STREET) (CROSS STREET)
a
a LOT
m SUBDIVISION LOT BLOCK SIZE
o BUILDING IS TO BE 72 FT. WIDE BY 24 FT. LONG BY FT. IN HEIGHT AND SHALL CONFORM IN CONSTRUCTION
ID
O
Z TO TYPE USE GROUP BASEMENT WALLS OR FOUNDATION
Ir (TYPE)
O REMARKS: CnnstiI;Y+ int, one—family resi denee
AREA
VOLUME 20010 ESTIMATED COST $_26,Qoo FEEMIT 8.00
(CUBIC/SQUARE FEET) P
OWNER Pat—rink M_ & Denise M_ Gnggins SuIL ING T.
ADDRESS _A6 Florence Road, NI tn_n_ BY
(Affidavit on reverse side of application to be completed by authorized agent of owner)
NNW