38B-124 (5) 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 01969 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 /�. ,'
`%/ �Zw `t-�'+iv Licenser
>
2. 3 /, 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.
Signatof applicant Address Application date
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 Is
OTHER Is
VI. ADDITIONAL PERMITS REQUIRED OR OTHER JURISDICTION APPROVALS
Date Date
Permit or Approval 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 r FOR DEPARTMENT USE ONLY
Permit number J
Building Use Group
Permit issued Imo' s 19 73
Building ( � Fire Grading
Permit Fee $ Live Loading
Certificate of Occupancy $ Occupancy Load
� A ved by: �,---�
Drain Tile
Plan Review Fee
TITLE
NOTES and Data — (For department use)
,y-e,-cs-r►t_
CITY OF NORTHAMPTON
OFFICE OF THE INSPECTOR OF BUILDINGS
212 MAIN STREET APPLICATION FOR
NORTHAMPTON, MA. 01060 3FS— /3 _ / PLAN EXAMINATION AND
/ BUILDING PERMIT
z
IMPORTANT — Applicant to complete all items in sections: 1, 11, 111, IV, and IX. O
ZONING
AT (LOCATION)
LOCATION (N0.) (STREET)
OF BETWEEN AND
BUILDING (CROSS STREET) (CROSS STREET)
LOT
SUBDIVISION LOT BLOCK SIZE
Vr
II. TYPE AND COST OF BUILDING — All applicants complete Parts A — D ;a
A. TYPE OF IMPROVEMENT D. PROPOSED USE — For"Wrecking" most recent use m
m
--I
1 ❑ New building Residential Nonresidential
2 ❑ Addition(IJ residential, enter number 12>Q.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— — — — --)� 20❑ Industrial
3 �,Alteration (See 2 above)
14❑ Transient hotel, motel, 21 ❑ Parking garage
4 ❑ Repair, replacement or dormitory — Enter number
• ------- — 22 ❑ Service station, repair garage
5 ❑ Wrecking (If multifamily residential, of units —�
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 — SpeciJy 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................ s 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 $ >
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 gPublic or private company 48• Number of stories................ Z
49. Total square feet floor area,
31 D&Wood frame 41 ❑ Private (septic tank, etc.)
all floors, based on exterior t
32❑ Structural steel dimensions ..................... %u
33❑ Reinforced concrete H. TYPE OF WATER SUPPLY
34❑ Other — Specify 42 Public 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 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 on elevator? 54. Number of Full..........
46 El Yes 47❑ No bathrooms
Partial.......
y
I hereby certify that the 'prgposed work is authorized by the- weer 'of record
and 1 have been authorized by the owner to make this applica#f s f
authorized agent. it W4- • _:.
SIGNATURE OF AGENT
ADDRESS
(NUMBER) (STREET) (CITY).
APPROVED BY TITLE
DATE 19
vr_ aC'. 5
DEPT. FILE COPY
Zp
BUILDING
DEPARTMENT OF BLDG. INSPECTIONS PERMIT% 212 STREET _ VALIDATION
NORTHAzeTON, MA. 01060 388 - 124
_DATE November 30, 19 7- PERMIT NO. �.g0
APPLICANT - Pnt7l anizPr Plumhing ADDRESS �i Main fii _ _ Fa.�ltharrminn
(N0.) (STREET (CONTR'S LICENSE)
PERMIT TO Alter Resi n NUMBER OF
ya..,�. '(�_ {�) STORY� ReS�Cj.�'I"1�'•P DWELLING UNITS 1
(TYPE OF IMPROVEMENT) NO. (PROPOSED USE)
ZONING
AT (LOCATION) 9 YCnl77mh 7g Air- DISTRICT I.MR
(NO,) (STREET)
a BETWEEN AND
w (CROSS STREET) - (CROSS STREET)
LOT
m SU901VISION LOT BLOCK SIZE
6
u O BUILDING IS TO BE FT. WIDE BY FT. LONG BY FT. IN HEIGHT AND SHALL CONFORM IN CONSTRUCTION
•
Z TO TYPE USE GROUP BASEMENT WALLS OR FOUNDATION
U. REMARKS: Thai ll her trin(3nttiT nPtr rn7tRidP [3nnri rPmovP stall hptrze n dining room & living rnnm*
install new carrying beam, new laundry room.
AREA OR PERMIT
VOLUME ESTIMATED COST .$-71 FEE $ 10.00
(CUBIC/SQUARE FEET)
OWNER TM nhael Ford P
ADDRESS 7P Cn317m lis Alva N7 i•^T1
(Affidavit on reverse side of application to be completed by authorized agent of owner)