29-367 (3) VIII. ZONING PLAN EXAMINERS NOTES INi 46
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 C1969 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.
7
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.
Signature of applicant Address Application date
1 ,
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
Permit or Approval Check Obtained Number By Permit or Approval Check ObtDa Date 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
Building Fire Grading
Permit Fee • Q�
Live Loading
Certificate of Occupancy $ Occupancy Load
Appro ed by:
Drain Tile $ ��
Plan Review Fee $
TITLE
NOTES and Data — (For department use)
mow.cif
CITY OF NORTHAMPTON
OFFICE OF THE INSPECTOR OF BUILDINGS
212 MAIN STREET APPLICATION FOR
NORTHAMPTON, MA. 01060 C9-p,. 3 Ice 7 PLAN UILD NMGNPERMNT AND
z
IMPORTANT — Applicant to complete all items in sections: 1, 11, 111, IV, and IX. O
a ZONING //��`�
I• AT (LOCATION) DISTRICT`
LOCATION (NO.) (STREET)
OF BETWEEN AND
BUILDING (CROSS STREET) (CROSS STREET)
LOT
SUBDIVISION LOT BLOCK SIZE
N
11. 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 5�] 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,
4 ❑ Repair, replacement or dormitory — Enter number 21 ❑ Parking garage
5 ❑ Wrecking (If multifamily residential, of units ——————— — --)P-
enter 22 E:] Service station, repair garage
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 �' '4`'''°'"" 27 ❑ Stores, mercantile
8 ❑ Private (individual, corporation, 28 ❑ Tanks, towers
�," F� 29 Other — Specify
nonprofit institution, etc.) ❑ p Jy
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 $
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 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 ill there be central air --• 52. Outdoors........................
36 ❑ Oil co itioning?
L. RESIDENTIAL BUILDINGS ONLY
37 Electricity 44 -_ No
❑ s S-o 45 ❑ �' S3. Number of bedrooms.
38�Coal �p.�
39 F-1 Other — Specify 9� -- t Will t re be an a ator? Full..........
54. Number of
46 ❑ Yes 47❑ No bathrooms
Partial.......
hereby certify that the proposed work is authorized by the., pyner of record
and I have been authorized by the owner to make this application a� his
authorized agent.
SIGNATURE 'OF`AGENT
ADDRESS
(NUMBER) (STREET) (CITY)
APPROVED BY TITLE
DATE 19
r
Zo
DEPT. FILE COPY
DEPARMW OF BUMDING nisPEGTiouS
BUILDING NW!Il T ST112
NORTHAMIEN, MAC 01060 PERMIT 4
a
VALIDATION
29 - 367
W DATE June 11,E 1934— PERMIT NO. 2%
APPLICANT Dennis Matthews ADDRESS 61 Austin Circle. Florence
(NO.) (STREET) (CONTR'S LICENSE)
NUME OF
PERMIT TO LTtilitX Shad (_�) STORY Utility ShOd DWELLING UNITS
(TYPE OF IMPROVEMENT) NO. (PROPOSED USE)
ZONING TMA
AT (LOCATION) 61 Atatin Ci ale DISTRICT
(NO.) (STREET)
a BETWEEN. AND
(CROSS STREET) (CROSS STREET)
O�
LOT
4 SUBDIVISION LOT BLOCK SIZE
m
a
U BUILDING IS TO BE 10 FT. WIDE BY Y 10 FT. LONG BY FT. IN HEIGHT AND SHALL CONFORM IN CONSTRUCTION
m
O
Z TO TYPE USE GROUP BASEMENT WALLS OR FOUNDATION
f (TYPE)
lY
OLL REMARKS: construct utility ahaci
AREA OR
VOLUME ESTIMATED COST 2.50.00 FEEMIT $ 10.00
(CUBIC/SQUARE FEET)
OWNER 73'11118 Mitthellm
B
ADDRESS 61 Austin Circle. norenee. Ma. B
(Affidavit on reverse: side of application to be completed by authorized agent of owner)