29-465 (5) VIII. ZONING PLAN EXAMINERS NOTES Af
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'iADENWICATION — To be completed by all applicants
Name Mailing address — Number, street, city, and .State ZIP code Tel. No.
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.
Si re of applicant Address Application date
�) - 1-1---�9 �
D0 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
Dote Permit or ApprovaI Check Obta ned 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 -_L/ � 9T 19 �
Building Fire Grading
Permit Fee $ Live Loading
Certificate of Occupancy $ Occupancy Load
Approved by:
Drain Tile $
Plan Review Fee $
T .LE
1p
"NOTES and Data — (For department use)
CITY OF NORTHAMPTON
OFFICE OF THE INSPECTOR OF BUILDINGS
212 MAIN STREET / / 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
�V ZONING
I• AT (LOCATION) ,� (mod �� �'+������ ; -�z_ - c DISTRIC
LOCATION ( O') (STREET)
OF BETWEEN AND
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
m
1 ❑ New building Residential Nonresidential
2 Addition(If residential, enter number 1215ZOne 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— — — — --> 20❑ Industrial
3 ❑ Alteration (See 2 above) 1q ransent hotel, motel,
❑ T i h tl 21 ❑ Parking garage
4 ❑ Repair, replacement or dormitory — Enter number
units ——————— — -i 22 ❑ Service station, repair garage
o
5 ❑ Wrecking (If multifamily residential, f
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 � ❑
17� Other — Specify .G �L ^
25 Public utility
7 F-1 Foundation only
26 ❑ School, library, other educational
B. OWNERSHIP a22AA&f??4R7 C1 -° 27 ❑ Stores, mercantile
8 ❑ Private (individual, corporation, (/ 28 E] 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 $ 500.
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❑ Other — Specify 42XPublic 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 Wi there be centra it 52. Outdoors........................
36 WOiI condi ping?
L. RESIDENTIAL BUILDINGS ONLY
37 ❑ Electricity 44 ❑ Y 45 ❑ No 53. Number of bedrooms..............
38 ❑ Coal
39 ❑ Other— Specify W' there be an elevator. Full..........
54. Number of
46 ❑ Yes 47❑ No bathrooms
Partial.......
INSPECTION RECORD
DATE NOTE PROGRESS - CRITICISMS AND REMARKS INSPECTOR
urn
a
D Tit OF BUILDING INSPECTIONS _ FIELD COPY
21 N``STREET
� 01060 BUILDING
29 _ 465 Cox #79 PERMIT
DATE _April 29, 1980 PERMIT NO. 212
APPLICANT RA al d No3nt ak ADDRESS 23 Crlc:tvieW Drive -_
(NO.) (STREET) (CONTR"S LICENSE)
NUMBER OF
PERMIT TO ( I STORY For �d-�h ttril�fl� SttbV$ DWELLING UNITS 1
(TYPE F IMPROVEMENT) NO. (PROPOSED USE)
ZONING
AT (LOCATION) 21 crestyl Tir DISTRICT
(N0.) (STRE
rn BETWEEN AND
(CROSS STREET) A X C 5 STREET)
L
n SUBDIVISION LOT BI E
m
a r
O BUILDING IS TO BE FT. WIDE BY L NG BY VUNDAT GHT AND SHALL CONFORM IN CONSTRUCTION
O 1V m
O
Z TO TYPE USE GROUP BASEMENT WALLS
f (TYPE)
O- REMARKS: Construct exterior t�aSdilar, Chimep • install wood-buraiAg stove in basemomt.
AREA OR VOLUME ESTIMATED COST $ 5W-VQ FEEMIT $ 1h W t)O
(CUBIC/SQUARE FEET) �
OWNER Ronald & .Joanle Wozniak `�! y
ADDRESS 23 Crestview Drive: Florence, Ma, 01060 BY BY _ PT.
! i.