29-080 (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 IMT ERNATIONAL, INC. . 'i'
IV. IDENTIFICATION — To be completed by all applicants
Name Mailing address — Number, street, city, and State ZIP code Tel. No.
Owner or
/ L�inf J qS �t` /v r f4unewee N
Lessee
Builder's
2, t L) 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 his application as his authorized agent and we agree to conform to all applicable laws of this jurisdiction.
Sig tur of p PW t Address Application date
it
DO NOT WRITE BELOW THIS LINE
V. PLAN REVIEW RECORD — For office use
Plans Review Required Check Plan Review Date Plans B Date Plans B Notes
4 Fee Started y Approved y
BUILDING
PLUMBING
MECHANICAL
ELECTRICAL Is
OTHER Is
VI. ADDITIONAL PERMITS REQUIRED OR OTHER JURISDICTION APPROVALS
Date Dote
Permit or Approval Check Obtained Number By Permit or Approval Check 0btta ned 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
Building Use Group
Permit issued 19�
Fire Grading
Building !�
Permit Fee l// Live Loading
Certificate of Occupancy $ Occupancy Load
Approved by:
Drain Tile $
Plan Review Fee $ L18el
TITLE
NOTES and Data — (For deportment use) '� #
CITY OF NORTHAMPTON 4 `^ z
OFFICE OF THE INSPECTOR OF BUILDINGS
212 MAIN STREET APPLICATION FOR
NORTHAMPTON, MA. 01060 PLAN EXAMINATION AND
c-I — 1jr6 BUILDING PERMIT
IMPORTANT — Applicant to complete all items in sections: 1, 11, 111, IV, and IX. O
ti ZONING
(• AT (LOCATION) DISTRICT
LOCATION (N0.) (STREET) it
OF BETWEEN
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 Residential Nonresidential
'2'M Addition(If residential, enter number 12 F-1 One family 18 ❑ Amusement, recreational
of new housing units added, if any,
in Part D, 13) 13 ❑ Two or more family — Enter 19 ❑ Church, other religious
number of units— — — — -� 20 ❑ Industrial
3 ❑ Alteration (See 2 above) 14 Transient hotel, motel,
21 ❑ Parking garage
4 ❑ Repair, replacement or dormitory — Enter number
5 ❑ Wrecking (If multifamily residential, of units ——————— — -- 22 ❑ Service station, repair garage
enter number of units in building in 15 ❑ Garage 23 ❑ Hospital, institutional
Part D, 13) 16 ❑
6 ❑ Moving (relocation) Carport � � 24 ❑ Office, bank, professional
17 Other — Specify 25 ❑ Public utility
7 ❑ Foundation only Y 26 ❑ School, library, other educational
B. OWNERSHIP 27 ❑ Stores, mercantile
Private (individual, corporation,
28 ❑ Tanks, towers
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,,,,,,,,,,,,,,,, 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 El Masonry (wall bearing) 40 ❑ 48. Number of stories.........
Public or private company """
31 Wood frame 41 ❑ Private (septic tank, etc.) 49• Total square feet of floor area,
all floors, base rior
32 Structural steel dimensions .. yx ...
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
F. PRINCIPAL TYPE OF HEATING FUEL I. TYPE OF MECHANICAL 51. Enclosed .......................
35❑ Gas Will there be central air 52. Outdoors........................
36 ❑ 0ii conditioning?
L. RESIDENTIAL BUILDINGS ONLY
37❑ Electricity 44❑ Yes 45 ❑ No 53. Number of bedrooms..............
38 ❑ Coal
39❑ Other — Specify Will there be an elevator? Full..........
54. Number of
46 ❑ Yes 47❑ No bathrooms
Partial.......
I hereby certify that the propo wcgk is authorized by the owner of record
and l have been authorized be owner to make this application as his
authorized agent.
SIGNATURE OF AGENT
ADDRESS
(NUMBER) (STREET) (CITY)
APPROVED BY TITLE
DATE 19
DEPT. FILE COPY
ZO
/y BUILDING
�! MI ■ VALI.DATIOIN
DATE 19 PERMIT NO. (
APPLICANT ADDRESS V
(N0.) (STREET) (CONTR'S LICENSE)
NUMBER OF
PERMIT TO�1�� O STORY DWELLING UNITS
TYPE OF PROVEMEN7j (FRO OSEO USE)
ZONING
AT (LOCATION) DISTRICT
(NO. (STREET) _
a BETWEEN AND
'o (CROSS STREET) (CROSS STREET)
a_
LOT
a
m SUBDIVISION LOT BLOCK SIZE
a
U BUILDING IS TO BE FT, WIDE BY FT. LONG BY FT. IN HEIGHT AND SHPLL CONFORM IN CONSTRUCTION
O
M cr
O
Z TO TYPE USE GROUP BASEMENT WALLS OR FOUNDATION
f (TYPE)
O
tt REMARKS:
VOLUME ESTIMATED COST $ � z FEEMIT /�} d
(CUBIC/SQUARE FEET) -f v
LA�
OWNER
BUILDING PT
ADDRESS BY
(Affidavit on reverse side of application to be completed by authorized agent of owner)