32C-123 (3) � 7
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 C1969 BUILDING OFFICIALS & CODE ADMINISTRATORS INTERNATIONAL, INC.
IV. IDENTIFICATION — To be completed by all applicants
Name Mailing address — Number, street, city, and State ZIP code Tel. No.
Owner or
Lessee
1 7 Builder's
2. � ��( / /� License No. CSC frr -Q,
v]G_,.
Contractor V
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 a lica Address Application date
DO 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
Permit or Approval I ec u
Obtained Check Date Number By Permit or Approval Check Date Obtained
PP 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 $1,!2 '/0 Live Loading
Occupancy Load
Certificate of Occupancy
Approved by:
Drain Tile
n
Plan Review Fee
TLE
s
NOTES and Data — (For department use)
a � y
� f
d
CITY OF NORTHAMPTON
OFFICE OF THE INSPECTOR OF BUILDINGS
212 MAIN STREET J APPLICATION FOR
NORTHAMPTON, MA. 01060 ` PLAN EXAMINATION AND
BUILDING PERMIT
z
IMPORTANT — Applicant to complete all items in sections. 1, 11, 111, IV, and IX. o
ZONING zi
I• AT (LOCATION) c DISTRICT
LOCATION (NO') (STREET)
OF BETWEEN AND—
BUILDING (CROSS STREET) (CROSS STREET)
LOT
SUBDIVISION LOT BLOCK SIZE
V1
ll. 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
i ❑ New building Residential Nonresidential
2 Addition(If residential, enter number
❑ 12,X One family 18 E] 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— — — — �_ 20❑ Industrial
3V Alteration (See 2 above)
14 ❑ Transient hotel, motel, 21 ❑ Parking garage
41❑ 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)
17 ❑ Other — Specify 25 ❑ Public utility
7 ❑ Foundation only
26 ❑ School, library, other educational
B. OWNERSHIP 27 ❑ Stores, mercantile
8'V Private (individual, corporation, 28 ❑ Tanks, towers
' onprofit 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 Other(elevator, etc.)............
11. TOTAL COST OF IMPROVEMENT I$
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, base e�gteri
32 Structural steel dimensions .
33 ❑ Reinforced concrete H. TOF WATER SUPPLY
34 F__1 Other — Specify 42 Pq Public or private company 50. Total land area, sq. ft. ...........
43 ❑ Private(well, cistern) K. NUMBER OF OFF-STREET
PARKING 51. Enclosed . .SPACE�- _
I
....
F. PRINCIPAL TYPE OF HEATING FUEL I. TYPE OF MECHANICAL
3 5Gas Will There be central air 52. Outdoors........................
3CM 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;&o bathrooms partial........
I hereby certify that the 'proposed work is authorized.by the orwner of erecerd
and 1 have been authorized by the owner to make this application as his
authorized agent. i -
�'
SIGNATURE O� AGENT \
ADDRESS `
(NUMBER) (STREET) (CITY)
APPROVED BY TITLE
DATE 19
e
DEPT. FILE COPY
DEPARTMENT OF BUILDING INSPECTIONS ZO
212 MAIN' STREET
BUILDING�t����i I IL
NORTE101PTON, Mk. 01060 PERMIT
VALIDATION
32C - 123
DATE July 122 t9 79 PERMIT NO. 319
APPLICANT _Zhunk 14AII ADDRESS SO. ill River Rd.} Deer- tell
(N0.) (STREET) (CONTR'S LICENSE)
NUMBER OF
PERMIT TO Alter reaidenc a (.-_) STORY kitchen DWELLING UNITS 1
(TYPE OF IMPROVEMENT) NO. (PROPOSED USE)
ZONING �C
AT (LOCATION) 28 ��mAt DISTRICT
(NO.) (STREET)
rn BETWEEN AND
(CROSS STREET) (CROSS STREET)
LOT
D SUBDIVISION LOT BLOCK-- SIZE
m
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
(TYPE)
IL REMARKS: aw kitchan_ophintata. 1 new Idndnw, alter existing wood stove
AREA OR
VOLUME ESTIMATED COST $ 3. PE $ 10.00
(CUBIC/SQUARE FEET)
OWNER Willi l i Am Ar=l d
ADDRESS 28 Fwait Street, Northam tom BYI ING EPT.
(Affidavit on reverse side of application to be completed by auto a agent of owner)