29-015 (2) YIII. ZONING PLAN EXAMINERS NOTES
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.
a
,IJV. IDENTIFICATION — To be completed by all applicants
Name Mailing address — Number, street, city, and State ZIP code Tel. No.
i. (I '2 `L !71/c KC v I�Q iLjOgi 1-119 wt -TeV 144 . ,
Owner or `LL '�L L't JjG (� C
Lessee
Bui Ider's
s �
License No.
2. C
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
i 00 NOT WRITE BELOW THIS LINE
V. PLAN REVIEW RECORD — For office use
Plan Review Date Plans B Date Plans B y Notes
Plans Review Required Check Fee Started y Approved
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 OTHER
VII. VALIDATION
Building FOR DEPARTMENT USE ONLY
Permit number 7�
Building Use Group
Permit issued ��^ � 19 �_
Fire Grading
Building
Permit Fee $ Live Loading
Occupancy Load
Certificate of Occupancy
Approved by:
Drain Tile
Plan Review Feel
TI E
NOTES and Data — (For department use)
C
ic
-Tblejr")& e-- rY 3 —2 7q-n 44ir, de, ;ble h ol!� qk
e4c
CITY OF NORTHAMPTON
OFFICE 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. G
ZONING p
I. AT (LOCATION) r' RII+G DISTRICTZ_!L
LOCATION (NO.) (STREET)
OF BETWEEN (CROSS STREET)
BUILDING (CROSS STREET) AND
LOT
SUBDIVISION LOT BLOCK SIZE
N
II. TYPE AND COST OF BUILDING — All applicants complete Parts A — D
M
A. TYPE OF IMPROVEMENT D. PROPOSED USE - For"Wrecking" most recent use m
1 ❑ New building Residential Nonresidential
2 Addition(If 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 ❑ Alteration (See 2 above) 14 Transient hotel, motel,
❑ 21 ❑ Parking garage
4 ❑ Repair, replacement or dormitory - Enter number
❑ of units ------- - -� 22 ❑ Service station, repair garage
5 Wrecking (if multifamily residential,
enter number of units in building in 15 ❑ Garage 23 ❑ Hospital, institutional
Part D, 13) 16 ❑ Carport 24❑ Office, bank, professional
6 ❑ Movin g (relocation) ❑relocation p ❑
17 Other - Specify 25 Public utility
7 ❑ Foundation only 26 ❑ School, library, other educational
B. OWNERSHIP 27 ❑ Stores, mercantile
28 F-1 Tanks, towers
8 Z 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,,•,,...•....... GCS C, 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 $
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❑ Masonry (wall bearing) 40 D< Public or private company 49. Total square feet of floor area,
31 FX Wood frame 41 ❑ Private (septic tank, etc.) all floors, based on exterior
32 ❑ Structural steel dimensions ..................... Z
33 ❑ Reinforced concrete H. TYPE OF WATER SUPPLY f�'���
50. Total land area, sq. ft. ...........
34❑ Other - Specify 42>< Public or private company
43 ❑ Private (well, cistern) K. NUMBER OF OFF-STREET
PARKING SPACES
51. Enclosed ...................... �I
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 45 X No 53. Number of bedrooms.............. Z+1
38 ❑ Coal
39 ❑ Other- Specify Will there be an elevator? Full.......... '
54. Number of
46 Yes bathrooms
❑ 47� No Partial....... f• '
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 application as -,his-
authorized agent.
r
SIGNATURE OF AGENT
ADDRESS
(NUMBER) (STREET), (CITY)
APPROVED BY TITLE
DATE 19
g
Q DEC P
T. FILE COPY
DEPARTMENT OF BUILDING INSPECTIONS Z o
212 MAIN STREET
NoRrMAMPtoy, MA, 01060 DJ I � Z )
PERMIT
VALIDATION
29 - 15 Code #79
DATE April' 7, 19 80 PERMIT NO. 170
APPLICANT RnI andDUpniR ADDRESS 74 Hi -kory Dr.. N'ton.
(N0.) (S REET) (CONTR'S LICENSE)
NUMBER OF
PERMIT TO, ddi t'inn (_1) STORY Addi ti on DWELLING UNITS 1
(TYPE OF IMPROVEMENT) NO. (PROPOSED USE)
ZONING
AT (LOCATION) 24 Hickory Drive DISTRICT TRA
(NO.) (STREET)
a BETWEEN AND
(CROSS STREET) (CROSS STREET)
LOT
D SUBDIVISION LOT BLOCK SIZE
m
Addition
0 XJQUM IS TO BE IR FT. WIDE BY 96 FT. LONG BY FT. IN HEIGHT AND SHALL CONFORM IN CONSTRUCTION
•
O
Z TO TYPE USE GROUP BASEMENT WALLS OR FOUNDATION
(TYPE)
C
REMARKS: -Addition a Pr npplit-atann
AREA OR PERMIT
VOLUME 9Af2 ESTIMATED COST $ 5 V o0o EE 15- 0
(CUBIC/SQUARE FEET)
t\
OWNER Rn1 anti junuis
BUI ING PT.
ADDRESS 24 Hi nknrT Dr.. N'ten. BY
(Affidavit on reverse side of application to be completed by author ent of owner)