79 VIII. ZONING PLAN EXAMINERS NOTES
DISTRICT ✓ '
USE -� - -�-%Y'a �° ^✓
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. IO,ENTIFICATION — To be completed by all applicants
Name Mailing address — Number, street, city, and State ZIP code Tel. No.
Owner or
Lessee
Builder's
License No.
2.
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 applic nt Address Application date
C 3 79
0 NOT WRITE BELOW THIS LINE
V. PLAN REVIEW RECORD — For office use
Plan Review Date Plans Date Plans
Plans Review Required Check Fee Started By Approved B y Notes
BUILDING $
PLUMBING $
MECHANICAL $
ELECTRICAL $
OTHER $
VI. ADDITIONAL PERMITS REQUIRED OR OTHER JURISDICTION APPROVALS
Date 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 I OTHER
VII. VALIDATION
Building FOR DEPARTMENT USE ONLY
Permit number �1
Building Use Group
Permit issued a 19- F-- Fire Grading
Building
Permit Fee $ �ti�. Live Loading
Occupancy Load
Certificate of Occupancy $
Approved by:
Drain Tile $
Plan Review Fee `
t 1
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. O
� ZONING �
I• AT (LOCATION) DISTRICT i' f,�„�,__ .
LOCATION (NO') (STREET)
OF BETWEEN AND
BUILDING (CROSS STREET) (CROSS STREET)
LOT
SUBDIVISION LOT _BLOCK SIZE
V1
II. TYPE AND COST OF BUILDING — A11 applicants complete Parts A — D
A. TYPE OF IMPROVEMENT D. PROPOSED USE — For"Wrecking" most recent use m
1 ❑'`New building ReKinl'ia' Non residential
2 Addition([/residential, enter number 12 One family 18 ❑ Amusement, recreational
of new housing units added, if any, 13 ❑ Two or more family — Enter 19 ❑ Church, other religious
in Part D, 13) -
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 F-1 Wrecking (I/multifamily residential, of units ——————— — —f 22 Service station, repair garage
enter number of units in building in 15 Garage 23 ❑ Hospital, institutional
Part D, 13) 24❑ Office, bank, professional
16 Carport
17 ❑ Other — Specify 6 ❑ Moving (relocation) 25 E] Public utility
7 ❑ Foundation only 26 ❑ School, library, other educational
B. OWNERSHIP 27 ❑ Stores, mercantile
26 ❑ 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
school, secondary school, college, parochial school, parking garage for,
10. Cost of improvement................
- 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 .....................
a
c. Heating, air conditioning..........
d. Other(elevator, etc.)............
11. TOTAL COST OF IMPROVEMENT $
III. SELECTED CHARACTERISTICS OF BUfLDING — 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) ] p company 48. Number of stories...... area ...
40 P blic or private cam an
49. Total square feat of floor area,
31 }RWood frame 41 ❑`rivate (septic tank, etc.) all floors, based on exterior,
32❑ Structural steel dimensions ......
33 NReinforced concrete H. TYPE OF WATER SUPPLY if
42 Public or private company 34❑ �Other — SpeciJy p p y 50. Total land area, sq. ft. ..
43 '1 vote(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 ❑ Oil conditioning? L. RESIDENTIAL BUILDINGS ONLY
37 ❑ Eleetriclf"yY 44❑ Yes 45 ❑ No 53. Number of bedrooms..............
38 ❑ Coal f
39❑ Other Specify Will therI%be an elevator? 54. Number of Full..........
46 ❑ Yes 47 ❑ No bathrooms Partial........
g •�
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 appficafion as his y
authorized agent.
t
SIGNATURE OF AGENT
I
ADDRESS
(NUMBER) (STREET) (CITY)
APPROVED BY TITLE
DATE 19
DEPT. FILE COPY
Zo
f a AR7� OF BUILD�9 IUSPECTIONS
212 SST t
NORTHMe s3 t ML. 01060 PERMIT VALIDATION
29-180
DATE Marsh tot 19 - 9 PERMIT NO. 77
APPLICANT_ Raward Moriarty ADDRESS 194 Brookside (hole
(NO.) (STREET) (CONTR'S LICENSE)
PERMIT TO New garage ( I ) STORY Detached garage NUMBER OF
DWELLING UNITS
(TYPE OF IMPROVEMENT) NO. (PROPOSED USE) 1
AT (LOCATION) 194 Brookside Circle ZONING
DISTRICT URA
(NO.) (STREET)
w BETWEEN. AND
`D
(CROSS. (CROSS STREET)
a_ I
d LOT
M SUBDIVISION LOT BLOCK SIZE
0 BUILDING IS TO BE 13 FT, WIDE BY 22 FT. LONG BY FT. IN HEIGHT AND SHALL CONFORM IN CONSTRUCTION
B
O
Z TO TYPE USE GROUP BASEMENT WALLS OR FOUNDATION
2
4K (TYPE)
w REMARKS* Construct one-car detached garage
AREA OR L^ PERMIT
VOLUME—_ 260 ESTIMATED COST $ 4,484 FEE $ 15.00
(CUBIC/SQUARE FEET)
OWNER Hmvard Moriarty �! /J
BUILDING E
ADDRESS 19 Brookside Circle, Florence, Ma. BY
(Affidavit on reverse side of application to be completed by authorized agent of owner)