35-163 (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 Q 0101600
Lessee •
Builder's
2 e ui 11A 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 lows of this jurisdiction.
Signat}tre of &nt,i Addr 1 Application date
l
00 NOT WRITE B LOW 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 is
VI. ADDITIONAL PERMITS REQUIRED OR OTHER JURISDICTION APPROVALS
Permit or Approval Check Date Number B Permit or Approval Check Date Number B
PP Obtained y PP Obtained 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 Use Group
Permit issued 197�7_
Fire Grading
Building t
Permit Fee $ {� O Live Loading
Occupancy Load
Certificate of Occupancy $
A o by:
Drain Tile
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
IMPORTANT — Applicant to complete all items in sections: 1, II, III, IV, and IX. O
ZONING
I• AT (LOCATION) DISTRICT` _
LOCATION (N0.) (STREET)
OF BETWEEN fs T
BETWEEN b 1 i?na AND
BUILDING (CROSS STREET) (CROSS STREET)
LOT
SUBDIVISION LOT BLOCK SIZE
Vr
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(11 residential, enter number 12[gOne 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 ❑ Carport 24❑ Office, bank, professional
6 ❑ Moving (relocation)
7 ❑ Foundation only 17g Other — SpeciJy 25 ❑ Public utility
26❑ School, library, other educational
B. OWNERSHIP 27 ❑ Stores, mercantile
8 X Private (individual, corporation, _�0 /� ' 28 ❑ Tanks, towers
nonprofit institution, etc.) �/��(!���%� yla 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 $ 7
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) 40 ❑ Public or private company 48• Number of stories................
31 Wood frame 41 � 49. Total square feet of floor area,Private (septic tank, etc.) ��
all floors, based on exterior /
32❑ Structural steel dimensions .......I............. Nc�M4ef 13,�SE
33❑ Reinforced concrete H. TYPE OF WATER SUPPLY
50. Total land area, sq. ft. ........... 7
34❑ Other — Specify 42 Public or private company y
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........................ ��1VG iv
36 Oil 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 0 No bathrooms Partial.....
r . t
hereby certify that the-proposed work is authorized by the owner of record
and 1 have been authorized by the owner to make this application as 'his
authorized agent.
SIGNATURE dF AGIENT '.
ADDRESS
(NUMBER) (STREET) (CITY)
APPROVED BY TITLE
DATE 19
t
DEPARDOW OF BUILDING INSPECTIONS DEPT. FILE COPY
212 MAIN STREET Z°
NORTHAMPTON, MA. 01060 BUILDING <a
35 — 163 PERMIT VALIDATION
DATE August 7, ig 79 PERMIT NO. -
APPLICANT Mariorie H. Sackett ADDRESS 807 Ryan 4
(N0.) (STREE (CONTR'S LICENSE)
PERMIT TO oonstruet Chjm�ev (�_j STORY mood_ 7rfp o NUMBER OF
(TYPE OF IMMPROVEMENT) N0. (PROPOSED S �e DWELLING UNITS 1_
ZONING
AT (LOCATION) 807 Ryan Road DIISTR CT SR.
(NO.) (STREET)
a BETWEEN Comer of BurU Pit Road AND Fly an Road
'O (CROSS STREET) (CROSS STREET)
O�
n. LOT
m SUBDIVISION LOT BLOCK SIZE
U
O -BUILDING IS TO BE FT. WIDE BY FT. LONG BY FT. IN HEIGHT AND SHALL CONFORM IN CONSTRUCTION
OD
O
Z TO TYPE USE GROUP BASEMENT WALLS OR FOUNDATION
f
� (TYPE)
° REMARKS: Construct masoaary exterior ahhimey for wood—bixmiug stove
AREA OR
VOLUME ESTIMATED COST $ 687,00 FEEMIT $ ln_W
(CUBIC/SQUARE FEET)
OWNER Russell F. & Marjorie H. Sackett au
ADDRESS 807 Baran Road. N[]L^'(b tcm. VA_ BY I T e&j
(Affidavit on reverse side of application to be completed by authorized agent of owner)