29-453 VIII. ZONING PLAN EXAMINERS NOTES
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NOTES
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BOCA FORM APEBP - 669 C1969 BUILDING OFFICIALS & CODE ADMINISTRATORS INTERNATIONAL, INC.
7IS DDIFICATION — To be completed by all applicants
Name Mailing address — Number, street, city, and .State ZIP code Tel. No.
I weer or '�✓ 4 6 s r✓C�`u} De,
Owner or
Lessee
Builder's
2 (f' 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 a plicant 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
9 Fee Started y Approved y
BUILDING $
PLUMBING $
MECHANICAL $
ELECTRICAL $
OTHER $
VI. ADDITIONAL PERMITS REQUIRED OR OTHER JURISDICTION APPROVALS
rova Number B
I Check Date umr Permit or Approval Check Date
Permit or A umer
pp Obtained y pp Number By
y
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 v
Building Use Group
Permit issued 3a 19
Fire Grading
Building
Permit Fee $ /D Od Live Loading
Occupancy Load
Certificate of Occupancy $
Approved by:
Drain Tile $
Plan Review Fee $ y
v
LE
NOTES and Data — (For department use)
r
CITY OF NORTHAMPTON
OFFICE OF THE INSPECTOR OF BUILDINGS
212 MAIN STREET APPLICATION FOR
NORTHAMPTON, MA. 01060 If _� PLAN EXAMINATION AND
BUILDING PERMIT
z
IMPORTANT — Applicant to complete all items in sections: 1, II, 111, IV, and IX. O
ZONING
DISTRICT
AT (LOCATION)
LOCATION (NO,) (STREET)
OF BETWEEN AND
BUILDING (CROSS STREET) (CROSS STREET)
LOT
SUBDIVISION LOT ,BLOCK SIZE
Vr
II. TYPE AND COST OF BUILDING — A11 applicants complete Parts A — D
A. TYPE OF IMPROVEMENT D. PROPOSED USE — For"Wrecking" most recent use m
m
1 ❑ New building Re 'dde{ntial Nonresidential
2 F-1 Addition(If residential, enter number 12 J� One family 18 ❑ Amusement, recreational
of new housing units added, if any, 13 Two or more family — Enter 19 ❑ Church, other religious
in Part D, 13) —
f units— — — � 20 ❑ Industrial
3 Alteration (See 2 above) number o
4/u�h 14 ❑ Transient hotel, motel, 21 E:] Parking garage
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 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�
a. Electrical.....................
b. Plumbing .....................
c. Heating, air conditioning..........
d. Other (elevator, etc.)............
11. TOTAL COST OF IMPROVEMENT $* ®Q
III. SELECTED CHARACTERISTICS OF BUILDING — For new buildings and additions, complete Parts E — L;
for wrecking, complete only Part J, for all others skip to IV.
E. PRINCIPAL TYPE OF FRAME G. TYPE OF SEWAGE DISPOSAL J. DIMENSIONS
30❑ Masonry (wall bearing) 40 Public or private company 48• Number of stories................
31 Wood frame 41 ❑ Private (septic tank, etc.) 49. Total square feet of floor area,
all floors, based onfxt�erio�r
32❑ Structural steel dimensions ...Y�� mil' `
33❑ Reinforced concrete H. TYPE OF WATER SUPPLY
34 F-1 Other — Specify 42 Public or private company 50. Total land area, sq. ft. ...........
43 ❑ Private (well, cistern) K. NUMBER OF OFF-STREET
PARKING SPACES
51. Enclosed ......................
F. PRINCIPAL TYPE OF HEATING FUEL I. TYPE OF MECHANICAL
35❑ Gas Will there be central air 52. Outdoors........................
36 Oil conditioning?
L. RESIDENTIAL BUILDINGS ONLY
37❑ Electricity 44 ❑ Yes 45 No 53. Number of bedrooms..............
38 ❑ Coal
39❑ Other — Specify Will there be an elevator? 54. Number of Full..........
46 ❑ Yes 47 kj_N a bathrooms
Partial.......
I hereby certify that the proposed work is authorized by the owneP )of•-xeccwd . .
and I have been authorized by the owner to make this application as his
authorized agent.
SIGNATURE OF AGENT
ADDRESS
(NUMBER) (STREET). 61TY r
APPROVED BY TITLE
DATE 19
DEPT. FILE COPY
OF BUIMING INSPECTIONS z°
te' BUILDING <a
INUTSMt NA. Olo6 PERMIT
VALIDATION
29 - 453 Code #79
DATE August 30, 19 79 PERMIT NO. 420
APPLICANT Henry Pasternak ADDRESS 4$ Crestview Drive
(N0.) (STREET) (CONTR'S LICENSE)
NUMBER OF
PERMIT TO t 141 STORY Residence DWELLING UNITS 1
(TYPE OF IMPROVEMENT) NO. (PROPOSED USE)
ZONING
AT (LOCATION)
Lot DISTRICT
URA
(NO.) (STREET)
a BETWEEN AND
m (CROSS STREET) - (CROSS STREET)-
a
LOT
m
SUBDIVISION LOT BLOCK SIZE
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)
Ir
° REMARKS: Complete 2nd. floor - 3 bedrooms, s bath
AREA OR P
VOLUME ESTIMATED COST $ 990.00 FEEMIT $ 10_00
(CUBIC/SQUARE FEET)
f
OWNER Henry Pasternak
BUILOI DE
ADDRESS 48 Oreysfyi ew Drive- No=thanton BY
(Affidavit on reverse side of application to be completed by authorize agent of owner)