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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.
Owner or
�\I 1., �-,e {l i _ .. J r l ��` i'-;• t,_f is r / S ) -
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
00 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
9 Fee Started Approved
BUILDING
PLUMBING
MECHANICAL
ELECTRICAL
OTHER
V1. ADDITIONAL PERMITS REQUIRED OR OTHER JURISDICTION APPROVALS
Permit or A Check Date Date
Number B Permit or Approval Check Number B
Approval ec Obtained u y PP Obtained um 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 /J Use Group
Permit issued 1974
Building Fire Grading
Permit Fee $ Live Loading
Occupancy Load
Certificate of Occupancy
Approved by:
Drain Tile
Plan Review Fee `1
TITLE
NOTES and Data — (For department use)
1 /
L Z,
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, III, IV, and IX. O
ZONING
tF-_ �{ )t`
I• AT (LOCATION) DISTRICT
LOCATION (N 0.) (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
—1
1 ❑ New building Resid tial Nonresidential
2
Addition(If residential, enter number 12 VOne family 18 ❑ Amusement, recreational
Kof new housing units added, if any, 13❑ Two or more family — Enter 19 ❑ Church, other religious
to Part D, 13)
number of units— — — — --> 20❑ Industrial
3 ❑ Alteration (See 2 above) 14 Transient hotel, motel,
❑ 21 ❑ Parking garage
4 ❑ Repair, replacement or dormitory — Enter number 22 ❑ Service station, repair garage
5 ❑ Wrecking (If multifamily residential, of units ——————— — --�
enter number of units in building in 15❑ Garage 23 ❑ Hospital, institutional
Part D, 13) 16 ❑ Carport 24❑ Office, bank, professional
6 ❑ Moving (relocation) 17X Other Specify
25❑ Public utility
—
7 ❑ Foundation only 26 ❑ School, library, other educational
B. OWNERSHIP Z, 27 ❑ Stores, mercantile
28 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,,,••,.......... W 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 $ �� t
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
48. Number of stories.....
30 El Masonry (wall bearing) 40�Public or private company
41'❑ Private (septic tank, etc.) 49. Total square feet of floor area,
31KWood frame p all floors, based on exterior
-J3 ❑ Structural steel dimensions .....................
33❑ Reinforced concrete H. TYP. OF WATER SUPPLY
34❑ Other — Specify .
42 % ublic 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 Will there be central air 52. Outdoors........................
36❑ Oil conditioning? L. RESIDENTIAL BUILDINGS ONLY
37 Electricity 44❑ Yes 45A No 53. Number of bedrooms..............
3 NCoal
39❑ Other— Specify Will there be an elevator? 54. Number of Full..........
46 ❑ Yes 47,,A Na bathrooms
Partial.......
hereby certify that the=proposed work is authorized by the owner,of record
and I have been authorized by the owner to make this application as his
authorized agent. n
SIGNATURE OF AGENT
ADDRESS
(NUMBER) (STREET) _ (CITY)
APPROVED BY TITLE
DATE 14
• P P
~ DEPT. FILE COPY
DEPARTME T OF BUE DING INSPECTIONS D°
212 MAIN STRM BUILDING
NORTHAfwJP`.C6Ni, MA. 01060 PERMIT
VALIDATION
29 _ 284
DATE July 26, 19_79 PERMIT NO. 344
APPLICANT Richard LABeau ADDRESS 12 Penoaaal Drive
(N0.) (STREET) (CONTR'S LICENSE)
OF
PERMIT TO Ci�lj1ffi1 f�) STORY ChiMna & 1400d stove DWELLRING UNITS
(TYPE OF IMPROVEMENT) NO, (PROPOSED USE)
ZONING
AT (LOCATION) 12 PananSall Drive DISTRICT
(NO.) (STREET)
a BETWEEN AND
�o (CROSS STREET) (CROSS STREET)
rn
LOT
IL SUBDIVISION LOT BLOCK SIZE
m
a
U
O BUILDING IS TO BE FT, WIDE BY FT. LONG BY FT. IN HEIGHT AND SHALL CONFORM IN CONSTRUCTION
Z TO TYPE USE GROUP BASEMENT WALLS OR FOUNDATION
(TYPE)
I
Ir
LL REMARKS: _J:ur,.L.=rjor ahimney and WhL;Id2]1]'C71iTlg g"tL3tTG .Al_.j)ina 8+f.'!Vg I3U 18b6l
AREA OR ESTIMATED COST $ 100000 FEEMIT : 10.00
VOLUME
(CUBfC/SQUARE FEET) I
OWNER i EIYI 7Yj LaRp- i]
BU D(NV,F.PT.
ADDRESS . 12 Penaasal Drive, Florence -- _- BY
(Affidavit on reverse side of application to be completed by authorized agent of owner)