29-392 (6) VIII. ZONING PLAN EXAMINERS NOTES y�
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.
V. IDENTIFICATION — To be completed by all applicants
j6 • Name Mailing address — Number, street, city, and State ZIP code Tel. No.
Owner or
Lessee 7
Builder's
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.
$ig re of applica t Address Application date
00 NOT WRITE BEL0Al 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 $ T
VI. ADDITIONAL PERMITS REQUIRED OR OTHER JURISDICTION APPROVALS
Permit or Approval Check Obtained Number By Permit or Approval Check Obtai ed Number By
BOILER PLUMBING
CURB OR SIDEWALK CUT ROOFING
ELEVATOR SEVIER
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 �9 t7
Building q Use Group
Permit issued i oC3 19 _
Building Fire Grading
Permit Fee $ 1_ 0 Live Loading
Certificate of Occupancy $ Occupancy Load
Approved by:
Drain Tile
Plan Review Fee
TITLE
NOTES and Data — (For department use)
CITY OF NORTHAMPTON
OFFICE OF THE INSPECTOR OF BUILDINGS _
212 MAIN STREET 3� APPLICATION FOR
NORTHAMPTON, MA. 01060 PLAN EXAMINATION AND
BUILDING PERMIT
z
IMPORTANT - Applicant to complete all items in sections: 1, 11\11,, 111, IV, and IX. O
I. AT (LOCATION) / '7 �1- ®.-� /i t —t llil Lj,! D ZONING
STR CT
LOCATION (NO() (STREET) �-
OF BETWEEN -AND
BUILDING (CROSS STREET) (CROSS STREET)
LOT
SUBDIVISION LOT__ BLOCK SIZE
V1
II. TYPE AND COST OF BUILDING - All applicants complete Parts A - D
A. TYPE OF IMPROVEMENT D. PROPOSED USE — For"Wrecking" most recent use Im
M
1 ❑ New building Residential Nonresidential
2 Addition(I residential, enter number
f 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 ❑ Wrecking (If multifamily residential, of units ------— -- --s 22 ❑ Service station, repair garage
enter number of units in building in 15 ❑ Garage 23 ❑ Hospital, institutional
Part D, 13) 16 ❑ Car p ort 24 ❑ Office, bank, professional
6 ❑ Moving (relocation)
[_1 17 Other — Specify / M/ 25 ❑ Public utility
7 Foundation only 7� -f
_ 6 ❑ School, library, other educational
B. OWNERSHIP 7 ❑ Stores, mercantile
8 ❑ Private (individual, corporation, 1 / 26 ❑ Tanks, towers
nonprofit institution, etc.) -"Ld a,e2` 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..........
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
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
F. PRINCIPAL TYPE OF HEATING FUEL I. TYPE OF MECHANICAL 51. Enclosed .......................
35 ® Gas Will condition be central air 52. Outdoors........................onng ditii ?
36 ❑ oil L. RESIDENTIAL BUILDINGS ONLY
37 ❑ Electricity 44❑ Yes,., ,49'1❑ No 53. Number of bedrooms..............
38 ❑ Coal
39 ❑ Other — Specify Will there a on a vator? 54. Number of Full..........
46 Yes 47 No bathrooms
Partial.......
I hereby certify-`that the proposed work is authorized the owner f
r"
and I have been authorized by the owner to make this application as this '
authorized agent.
SIGNATURE OF AGENT
ADDRESS [
(NUMBER) (STREET) .CITY)
APPROVED BY TITLE
DATE 19
DEPT. FILE COPY
DEPART 14M OF BUILDING INSPECTIONS ZC
NO � O212 SBMT MA.. 01 LV a
f,
PERMIT
1* VALIDATION
29 - 392
DATE kwast 23, 19 X72 PERMIT NO. 397
APPLICANT Sue K=aris ADDRESS 77 Brookwood Drive
(NO.) (STREET) (CONTR'S LICENSE)
NUMBER OF
PERMIT TO STORY Wood .h77R1 jr 8'tioye DWELLING UNITS 1
(TYPE OFrI�MPR OYEMENT) N0. (PROP0SE0 UaE)
AT (LOCATION) 7( Brookmod Drive ZONING
D ISTR!CT
(NO.) (STREET)
BETWEEN AND
(CROSS STREET) (CRASS STREET)
LOT
SUBDIVISION LOT BLOCK_ SIZE
BUILDING IS TO BE FT. WIDE BY FT. LONG BY FT. IN HEIGHT AND SHALL CONFORM IN CONSTRUCTION
TO TYPE USE GROUP BASEMENT WALLS OR FOUNDATION
(TYPE)
REMARKS: - - - -Exterior Binder block Qbi)MM & woodrburnixg stove
AREA OR P
VOLUME ESTIMATED COST .$_ 1 X00 FEEMIT . 10.40
(CUBIC/SQUARE FEET) 1 .
OWNER john E_ & Sue Ann Karl aria
ADDRESS 77 Brool=od Drive- Elton,
ton, — I L
(Affidavit on reverse side of application to be completed by authorized agent of owner)