29-319 (6) VIII. ZONING PLAN EXAMINERS NOTES wdw
DISTRICT
USE
A
FRONT YARD
SIDE YARD SIDE YARD
t•
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
o— Name Mailing address — ;Number, street, city, and State ZIP code Tel. No.
1. ._
Owner or 1T �%/ ✓� L�� /7-C./�L �Qt �1� A'IV I= �.'l�/
Lessee r �(
Builder's
L.
License No.
Contractor l-
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 o applican 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
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 FOR DEPARTMENT USE ONLY
Permit number
Building Use Group
Permit issued 19
Building � Fire Grading
Gr Ct
Permit Fee $ �/ Live Loading
Certificate of Occupancy $ Occupancy Load
APPr by'
Drain Tile ��� �
Plan Review Fee
TITLE
NOTES and Data — (For department use) ����
CITY OF NORTHAMPTON
�. + MASSACHUSETTS
OFFICE OF THE INSPECTOR OF BUILDINGS
APPLICATION FOR
PLAN EXAMINATION AND
BUILDING PERMIT
z
IMPORTANT — Applicant to complete all items in sections: 1, 11, 111, IV, and IX. 0
ZONIN���/,//�
(• AT (LOCATION) -./t'L > _!(_•f']f !0/l I /I...- DISTRICT
LOCATION (Na.) (STREET)
OF BETWEEN AND
BUILDING (CROSS STREET) (CROSS STREET)
LOT
SUBDIVISION LOT BLOCK SIZE
to
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 12 ® 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
5 F-1 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. Electrical.....................
b. Plumbing .....................
c. Heating, air conditioning.......... 'LeC r-,
d. Other (elevator, etc.).............
11. TOTAL COST OF IMPROVEMENT Is
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 Cad 7Xx�
30[—] Masonry (wall bearing) 40 >< Public or private company 48• Number of stories................
31 CK 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 42 D< 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 ❑ CiI conditioning? L. RESIDENTIAL BUILDINGS ONLY
37 D�q Electricity 44 ❑ Yes 45N No 53. Number of bedrooms..............
38 ❑ Coal
39❑ Other — Specify Will there be an elevator? 54. Number of Full..........
46 ❑ Yes 47 K No bathrooms
Partial.......
I 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`OF AGENT"
ADDRESS . . _.
(NUMBER) (STREET) (CITY)
APPROVED BY TITLE
DATE 19
DEPT. FILE COPY
Zp
CITY OF NORTHAMPTON 29-319 BUILDING Qa
PERMIT
VALIDATION
DATE June 221, 19 78 PERMIT NO. p5f)
APPLICANT, Robert Jedanowskl ADDRESS 423 Aebrook Dri V .. +9 n
(NO.) (STREET) (CONTR'S LICENSE)
NUMBER OF
PERMIT TO Addition STORY,? bedrnoM DWELLING UNITS L
(TYPE OF IMPROVEMENT) NO. (PROPO O USE)
ZONING
A
AT (LOCATION) _4_3 Arrahrnnk Drj�a __- DISTRICT
(NO.) (STREET)
a BETWEEN AND
10 (CROSS STREET) (CROSS STREET)
LOT
m SUBDIVISION LOT BLOCK SIZE
a Addition
U BUILDING IS TO BE 2� FT. WIDE BY 30-FT. LONG BY FT. IN HEIGHT AND SHALL CONFORM IN CONSTRUCTION
m
Z TO TYPE USE GROUP BASEMENT WALLS OR FOUNDATION
(TYPE)
2
I
O 1
LL REMARKS: bath
AREA OR PERMIT
VOLUME 810 ESTIMATED COST $ 7,000 FEE 2� ••��
(CUBIC/SQUARE FEET)
OWNER Robert & Mary Jedanowski BU
ADDRESS 42: Anrabrank Thrive, F'lprenrf? M�q_ B
(Affidavit on reverse side of application to be completed by authorized agent of owner)