29-023 (3) VIII. 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 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
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.
Situ of app 'cant Address Application date
d
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
Fee Started 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
Bui Iding / Use Group
Permit issued 0 19 �
Building r Fire Grading
Permit Fee �.f�� Live Loading
Certificate of Occupancy $ Occupancy Load
Approved by:
Drain Tile
Plan Review Fee $ ?7�
IT E
NOTES and Data — (For department use)
1
r
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) DISTRIC
LOCATION (NO.) (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
M
1 ❑ New building Reside tial Nonresidential
2 Addition(If residential, enter number 12FOne 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— — — —
3 ❑ Alteration (See 2 above) 2 ❑ Industrial
14❑ Transient hotel, motel, 21 1 ❑ 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)
7 ❑ Foundation only 17:K Other — Specify � 25 ❑ Public utility
26 ❑ School, library, other educational
B. OWNERSHIP / 27 ❑ Stores, mercantile
8 ❑ Private (individual, corporation, J p� / 28 ❑ Tanks, towers
nonprofit institution, etc.) / a L?tfd 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 $
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) 401S;�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 F-1 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 Xonelev 52. Outdoors........................
con
36 ❑ Oil L. RESIDENTIAL BUILDINGS ONLY
37 Electricity 44 o 53. Number of bedrooms..............
38 Coal
39❑ Other — Specify Will 54. Number of Full..........
46 Yes 47❑ No ba throoms
Partial.......
hereby certify that the proposed work is authorized by the owner o record
and I 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
DEPT. FILE COPY
DEPARTMENT OF BUILDING INSPECTIONS ;o
212 MAIN STREET BUILDING
i&THZIPT11IN, MA, 01060 PERMIT
VALIDATION
29 - 23
DATE Junp 4s 19 PERMIT NO. 292
APPLICANT Cheri pg RaAy_4 ejd[!2 ADDRESS 6 A;=h 1 1 Rd
(NO.) (STREET) - (CONTR'S LICENSE)
NUMBER OF
PERMIT TO flb1R�11n pnol (_I—) STORY T-�}�TTOUAd ^C101 DWELLING UNITS
(TYPE OF I§7PROWNT) N0. (PROPOSED USE)
ZONING
AT (LOCATION) 6 84rrh Hilt Rd- DISTRICT URA
(NO.) (STREET)
a BETWEEN AND
u (CROSS STREET) (CROSS STREET)
a
LOT
m SUBDIVISION BLOCK SIZE
a
U
O BUILDING IS TO BE FT. WIDE BY T. L I FT. IN HEIGHT AND SHALL CONFORM IN CONSTRUCTION
Z TO TYPE USE GROUP Is EME T WALLS OR FOUNDATION
� (TYPE)
0 jjj4_jr .36
LL REMARKS: Tnstjkll In-ground
AREA OR PERMIT
VOLUME ESTIMATED COST $ 22 FEE $
(CUBIC/SQUARE FEET)
P
OWNER Cber1 e@ ltady4 e f Z
BUI ING T.
ADDRESS M r jj HILL Rd.v N g to— BY
(Affidavit on reverse side of application to be completed by outhonz ent of owner)