29-262 (4) VIII. ZONING PLAN EXAMINERS NOTES
DISTRICT Qi
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. IEENTIFICATI N — To be completed by all applicants
`� Name' Mailing address — Number, street, city, and State ZIP code Tel. No.
Owner or '
Lessee 7 /`}
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
r '
DO NOT WRITE BELOW 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
VI. ADDITIONAL PERMITS REQUIRED OR OTHER JURISDICTION APPROVALS
Permit or A rova I Check Date Number B Permit or A rova I Check Date Number B
Pp Obtained y Pp Obta ined y
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 19'2
Fire Groding
Buildings-1
Permit Fee $ �" _ -0. `�� Live Loading
Occupancy Load
Certificate of Occupancy
April ed by:
Drain Tile I� t
Plan Review Fee `
TITLE
NOTES and Data (For department use)
i►
S CITY OF NORTHAMPTON
OACE OF THE INSPECTOR OF BUILDINGS
212 MAIN STREET APPLICATION FOR
NORTHAMPTON, MA. 01060
,� �' PLAN EXAMINATION AND
BUILDING PERMIT
IMPORTANT — Applicant to complete all items in sections: 1, 11, 111, IV, and IX. O
' ZONING
y; �,..'- .Y' r, P ,, !.�"' 'r
AT (LOCATION) 1 DISTRIC.
LOCATION (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 m
M
1 New building Residential Nonresidential
2 Addition(if residential, enter number 12 I—J One family 18 ❑ Amusement, recreational
of new housing units added, if any,
in Past D, 13) 13 Two or more family - Enter 19 ❑ Church, other religious
number of units- - - - -> 20 ❑ Industrial
3 Alteration (See 2 above) 14 l
t
l
t
t h
i
Transenoe , motel,❑ 21 ❑ Parking garage
4 ❑ Repair, replacement or dormitory - Enter number
22 ❑ Service station, repair garage
5 ❑ Wrecking (If multifamily residential, of units ------- - -� P 9 9
enter number of units in building in 15 ❑ Garage 23 ❑ Hospital, institutional
Part D, 13) 16 ❑
Carport 24❑
6 ❑ Moving (relocation) Office, bank, professional
� Jam'/r
7 F-1 Foundation only 17 ❑ Other - Specify 25 ❑ Public utility
!/ 26 ❑ School, library, other educational
B. OWNERSHIP ."-'(-g' 27 ❑ Stores, mercantile
8 Private (individual, corporation, / 28 ❑ Tanks, towers
nonprofit institution, etc.) 1. 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 $ L tom`"Y
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 j
30❑ Masonry (wall bearing) 40 7,� 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 WiKihere be central air 52. Outdoors........................
conditioning? \_
36 ❑ Oil L. RESIDENTIAL BUILDINGS ONLY
37® Electricity 44❑^Yes-- No 53. Number of bedrooms.............. ._,j
38 ❑ Coal
39❑ Other - Specify Will there'ie an elevator? Full..........
54. Number of
48❑ Yes 47❑ No bathrooms
Partial.......
hereby-certify that the proposed work is authorized by the -owner of cord
and t 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
tot
DEPT. FILE COPY
4
BUILDING m�
PERMIT ���
VALIDATION
aa -4
DATE " 19 PERM.�I NO.
APPLICANT DDRESS
(NO.) TREET) (CONTR'S LICENSE)
NUMBER OF
PERMIT TO (,) STORY DWELLING UNITS
(TYPE OF IMPROVEMENT) NO. (PROPOSED USE)
ZONING
AT (LOCATION) DISTRICT
(NO.) (STREET)
rn BETWEEN AND
'o (CROSS STREET) (CROSS STREET)
a
LOT
D' SUBDIVISION LOT BLOCK SIZE
m
U
O BUILDING IS TO BE FT. WIDE BY FT. LONG BY FT. IN HEIGHT AND SHALL CONFORM IN CONSTRUCTION
m
C)
Z TO TYPE USE GROUP BASEMENT WALLS OR FOUNDATION
E (TYPE)
M
O / _• _
LL REMARKS:
AREA OR VOLUME _ ESTIMATED COST $ —0P PERMIT
(CUBIC/SQUARE FEET)
i
OWNER
BUILDI
ADDRESS BY
(Affidavit on reverse side of application to be completed by authorized agent of owner)