29-302 (5) V111. ZONING PLAN EXAMINERS NOTES
DISTRICT
USE
FRONT YARD
SIDE YARD SIDE YARD
REAR YARD
NOTES
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BOCA FORM APEBP — 669 C1969 BUILDING OFFICIALS & CODE ADMINISTRATORS INTERNATIONAL, INC.
IV. IDENTIFICATION — To be completed by all applicants
ZName Mailing address — Number, street, city, and State ZIP code Tel. No.
Owner or
Lessee
Bui Ider'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.
Signature of 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 $
OTHER
V1. ADDITIONAL PERMITS REQUIRED OR OTHER JURISDICTION APPROVALS
Dae Date
Permit or Approval Check Obtained 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 DEPARTMENT USE ONLY
Permit number `•J
Building Use Group
Permit issued OLII� 1979
Building
Fire Grading
Permit Fee $ u Live Loading
Certificate of Occupancy $ Occupancy Load
Ap d by:
Drain Tile $ � D
Plan Review Fee $
TITLE
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
IMPORTANT - Applicant to complete a// items in sections: 1, 11, 111, IV, and IX. O
ZONING
• AT (LOCATION) �r` —"�'�' —"V I D STR C .
LOCATION (NO.) (STREET) ^^TT��
OF BETWEEN AND
BUILDING (CROSS STREET) (CROSS STREET)
LOT
SUBDIVISION LOT BLOCK SIZE
CA
II. TYPE AND COST OF BUILDING - All applicants complete Parts A - D -i
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 12 F><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) 1q ransenoe , motel,❑ Transient hotel, tl 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 F-1 Moving (relocation) R
17 ❑ Other — Specify 25 E] Public utility
7 ❑ Foundation only 26 ❑ School, library, other educational
B. OWNERSHIP h-i.�T 7 ❑ Stores, mercantile
❑8 � Private (individual, corporation, 28 Tanks, towers.M �j�,
nonprofit institution, etc.) ' �` '/`" zy ❑ 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,,,,,,,,•,,,,,,, �o c) '! 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 $_ c U
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 r'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 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>�e HANICAL
35 ❑ Gas ntral air 52. Outdoors........................
36 ❑ Oil L. RESIDENTIAL BUILDINGS ONLY
37X Elec tricity 45 ❑ No 53. Number of bedrooms..............
38 ❑ Coo I
39 ❑ Other — Specify elevator. Full..........
54. Number of 47❑ No bathrooms
Partial.......
1 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 OE' AGENT
ADDRESS �. .
(NUMBER) (STREET) (CITY)
APPROVED BY TITLE
DATE 19
NINON
.DEPT. FILE COb�,
DEPARMW OF BUILDING INSPECTIONS BUILDING 'I a CA�► a��
212 MAIN STREET Q
_NORTH[AKMN, 14A.. 01 060 PERMIT
VALIDATION
29 - 302 Code #79
DATE netober 10_. 19_7-9 PERMIT NO. 581
APPLICANT Z,, F. G18szcz ADDRESS 422 Acrebrook Dmve
(NO.) (STREET) (CONTR'S LICENSE)
NUMBER OF
PERMIT TO Imci:al l a}y V R VP.) STORY 1,10nCI..t]11Y'Yt' 4'I:OVe DWELLING UNITS
(TYPE OF IMPROVEMEN NO. (PROPOSED USE)
ZONING �
AT (LOCATION) 47 Aorehrnok Drive DISTRICT 1�
(NO.) (STREET)
o. BETWEEN AND
O�
(CROSS STREET) (CROSS STREET)
LOT
IL SUBDIVISION LOT BLOCK SIZE
m
a
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)
It
U. REMARKS: Install n w hlc> k nhimney for wood b12Y7Ljng stove.
VOLUME ESTIMATED COST $ 300*00 FEE MIT 10.00
(CUBIC/SQUARE FEET)
OWNER 7 GlaazcZ
ADDRESS _ 422 _A_erebrook Dr7 ve} Florence t Ma, 01060 B LD T �1
(Affidavit on reverse side of application to be completed by authorized agent of owner)