29-383 (5) VIII. ZONING PLAN EXAMINERS NOTES
DISTRICT
USE
FRONT YARD
SIDE YARD SIDE YARD
REAR YARD
NOTES
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BOCA FORM APEBP — 669 01969 BUILDING OFFICIALS & CODE ADMINISTRATORS INTERNATIONAL, INC.
�I '. ENTIFICATION — To be completed by all applicants
Name Mailing address — Number, street, city, and State ZIP code Tel. No.
mac` +` C� {'. /�' l -(/V , � a�
Qwner 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
DO 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 Is
OTHER Is
VI. ADDITIONAL PERMITS REQUIRED OR OTHER JURISDICTION APPROVALS
Date Date
Permit or Approval Check Obttai ed 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 Lj
VII. VALIDATION
Building 9� FOR DEPARTMENT USE ONLY
Permit number
Building Use Group
Permit issued 19�
Building �— Fire Grading
Permit Fee $��/J� Live Loading
Certificate of Occupancy $ Occupancy Load
Approved by:
Drain Tile $
Plan Review Fee /
_M j T
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. 0
t, fzo ZONING I
• AT (LOCATION) '( ��/�o d r r -10 / j
Il0 ` DISTRICT ?
LOCATION (NO.) (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 Re d tial Nonresidential
2,N Addition(If residential, enter number 12One family 18 ❑ Amusement, recreational
of new housing u its added, if any,
in Pa t D, 13) ` L�yvtiv 13❑ Two or more family — Enter 19 ❑ Church, other religious
Ly1J ��l number of units— — — — > 20 ❑ Industrial
3 F-1 Alteration See 2 above)
14❑ Transient hotel, motel, 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)
17�Other — Specify 25 ❑ Public utility
7 F-1 Foundation only
26 ❑ School, library, other educational
B. OWNERSHIP _. -��/f'+ti� / 27 ❑ Stores, mercantile
28 E] Tanks, towers
8 Private (individual, corporation,
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,,,•,,,••••••••, f.�t• Q school, secondary school, college, parochial school, parking garage for,
department store, rental office building, office building of 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 $ 00, 00
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 kPublic 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 concretes H. TYPE OF WATER SUPPLY
� Other — Specify ,Jrr I� 42�Public or private company 50. Total land area, sq. ft. ...........
34
\� 43 ❑ Private (well, cistern) K. NUMBER
PARKING OSPACESSTREET
51. Enclosed .......................
F. PRINCIPAL TYPE OF HEATING FUEL I. TYPE OF MECHANICAL
35 ❑ Gas Will there be central air 52. Outdoors........................
conditioning?
36 ❑ Oil L. RESIDENTIAL BUILDINGS ONLY
37 ,EElectricity 44 ❑ Yes 45 NJ:�No 53. Number of bedrooms..............
38 ❑ Coal
39❑ Other — Specify Will there be an elevator? Full..........
54. Number of
46 ❑ Yes 47�o bathrooms
Partial.......
hereby certify that the Proposed work is authorized by the owner
and I have been authorized by the owner to make this application f cord
as
authorized agent. his
SIGNATURE OF AGENT
.ADDRESS
(NUMBER) (STREET)
(CITY)
APPROVED BY
TITLE
DATE_ 19
/��
et
DEPT. FILE COPY
DEPARTMENT OF BUILDING INSPECTIONS ZQ de;�;r�
212 MAIN STREET BUILDING a'L
NoRmAwTON, rya.. o1o6o PERMIT
VALIDATION
29 - 383
DATE August 20, 19 79 PERMIT NO. 391 APPLICANT_ RaZel M. Tardy ADDRESS 27 Brookwood Dr. j Fla.
(NO.) (STREET) (CONTR'S LICENSE)
PERMIT TO Install Ch l$. 8c StA1TBr �_j STORY__ For wood big atoye DWELLING UNITS
(TYPE OF IMPROVEMENT) NO. (PROPOSED USE)
AT (LOCATION) �ry7 Rr pnkwoad Ive Florence ZONING
(N0.) DISTIR ICT
(STREET) URA
a BETWEEN - AND
m (CROSS STREET) - .(CROSS STREET)
a
n LOT
SUBDIVISION LOT BLOCK SIZE
a
0 BUILDING IS TO BE FT. WIDE BY FT. LONG BY FT. IN HEIGHT AND SHALL CONFORM IN.CONSTRUCTION
O
m
O
Z TO TYPE USE GROUP BASEMENT WALLS OR FOUNDATION
f
It (TYPE)
W REMARKS: TnialtitIl brink xterinr r_bi=Ay and wood-Wrr±ing etove
VOLUME ESTIMATED COST W %0.00 PERMIT .� 10.00
(CUBIC/SQUARE FEET)
OWNER Hazel M_ TArdy
PT
ADDRESS 2-7 o a l j"'Ime,_lo,
(Affidavit on reverse side of application to be completed by authorized agent of owner)