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DISTRICT
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FRONT YARD 30
SIDE YARD 2Ao SIDE YARD �J
REAR YARD ffO
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 &S� J`
Lessee
12. Builder's
'V /✓ /7�� 4111 Vi e'/ License No.
Contractor
3. 1`u � J`'�z✓ ��s5
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.
Sign ture f applicant Address Address Application date
D0 NOT WRITE BELOW THIS LINE
V. PLAN REVIEW RECORD — For office use
Plan Review Date Plans Date Plans
Plans Review Required Check Fee Started By Approved BY Notes
BUILDING
PLUMBING
MECHANICAL
ELECTRICAL
OTHER
VI. ADDITIONAL PERMITS REQUIRED OR OTHER JURISDICTION APPROVALS
Dae 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 Ll
VII. VALIDATION
Building FOR DEPARTMENT USE ONLY
Permit number
Building Use Group
Permit issued /4 19
Buildings Fire Grading
Permit Fee / 0 D
Live Loading
Certificate of Occupancy $ Occupancy Load
Approved by:
Drain Tile $ G2,e-� �
Plan Review Fee $
TITLE
NOTES and Data — (For department use)
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. G,/i S/,-? o
P 40z � / 1 / p ZONING A4` Al
AT (LOCATION) n 1�.2n L 6 1.2d )( k)AP F���!/£ SJ/��)L 11J DIS RICT c��
LOCATION r� (N0.)T (STREET) 1 2Lp/J
OF '`'��✓�7�'�7(� lU.sril d2 fiax-C ern AND g /V 3
BUILDING (CROSS STREET) (CROSS STREET)
LOT }'d�
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 ❑ Addition(If residential, enter number 12® One family 18 ❑ Amusement, recreational
of new housing units added, if any,
in Part D, 13) 13 F-1 Two or more family — Enter 19 ❑ Church, other religious
3 ❑ Alteration (See 2 above)
number of units— — — — --i� 20 ❑ Industrial
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 y Garage 23 ❑ Hospital, institutional
Part D, 13)
6 ❑ Moving (relocation) 16 ❑ Carport 24❑ Office, bank, professional
17❑ Other — Specify 25 ❑ Public utility
7 ❑ Foundation only
26 ❑ School, library, other educational
B. OWNERSHIP 27 ❑ Stores, mercantile
28 ❑ Tanks, towers
8 F\/1 Private (individual, corporation, Specify
Other —
nonprofit institution, etc.) 29 ❑ p fy
9 ❑ Public (Federal, State, or
local government)
C. COST (Omit cents) Nonresidential — Describe in detail proposed use of buildings, e.g., food
t'�n/Ye/ 01(J c� processing plant, machine shop, laundry building at hospital, elementary
10. Cost of im rovemen f1 school, secondary school, college, parochial school, parking garage for,
p ...... 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 I$,_U60'p0
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 L❑ Masonry (wall bearing) 40 ❑ Public or private company 48• Number of stories................ f t
31 Wood frame 41 Private (septic tank, etc.) 49. Total square feet of floor area, �{Q—L.Z8
all floors, based on exterior //!!
32 ❑ Structural steel dimensions ..................... ZV
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 ...................... L
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 � No
® Y ❑ 53. Number of bedrooms.............
38 ❑ Coal
39 ❑ Other — Specify Will there be an elevator? 54. Number of Full..........
46 ❑ Yes 47® No bathrooms
Partial.......
y,
NOT
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