35-157 (5) VIII. ZONING PLAN EXAMINERS NOTES
DISTRICT
USE
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FRONT YARD 3G� �
SIDE YARD 24' 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.
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.
Signature of applicant Address Application date
00 NOT WRITE BELOW THIS LINE
V. PLAN REVIEW RECORD — For office use
Plans Review Required Check Plan Review Dote Plans B Date Plans By Notes
By Fee Started Approved
BUILDING $
PLUMBING $
MECHANICAL $
ELECTRICAL $
OTHER $
VI. ADDITIONAL PERMITS REQUIRED OR OTHER JURISDICTION APPROVALS
Permit or A rovaI ec Number Obtained Chk Date Dote
PP Nber By Permit or Approval Check 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 /�E Q'�
Permit Fee $ ! Live Loading
Occupancy Load
Certificate of Occupancy $
Ap d by:
Drain Tile $
Plan Review Fee $ LJ
TITLE
NOTES and Data — (For department use)
/ t
--!`J
CITY OF NORTHAMPTON
OFFICE OF THE INSPECTOR OF BUILDINGS
212 MAIN STREET APPLICATION FOR
NORTHAMPTON, MA. 01060 3� 1',S—7 PLAN EXAMINATION AND
BUILDING PERMIT
z
IMPORTANT — Applicant to complete all items in sections: 1, 11, III, IV, and IX. (� O
`1 tJ ZONING
DI �\
rte- T S TRICT"'
AT (LOCATION)
LOCATION (NO') (STREET)
OF BETWEEN AND
BUILDING (CROSS STREET) (CROSS STREET)
LOT
SUBDIVISION LOT BLOCK SIZE
to
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 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) 25 ❑ Public utility
17 ❑ Other — Specify
7 ❑ Foundation only ( ,t ( r/ 26 ❑ School, library, other educational
B. OWNERSHIP i 27 ❑ Stores, mercantile
8 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................ �T_Ucl " 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.)............ cL,
11. TOTAL COST OF IMPROVEMENT $"9
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 f 7�
48. Number of stories................
30❑ Masonry (wall bearing) 40 ❑ Public or private company
49. Total square Feet of floor area,
31 Wood frame 419 Private (septic tank, etc.) all floors, based on exterior
32 Structural steel dimensions .....................
33 ❑ Reinforced concrete H. TYPE OF WATER SUPPLY
34 ❑ Other — SpeciJy
42 Public or private company 50. Total land area, sq. ft. ...........
43 ❑ Private (well, cistern) K. NUMBER OF OFF-STREET
PARKING SPACES
51. Enclosed ......................
F. PRINCIPAL TYPE OF HEATING FUEL I. YPE OF MECHANICAL
35❑ Gas WiI here be central air 52. Outdoors........................
36 R] Oil conditi ing? L. RESIDENTIAL BUILDINGS ONLY
37 ❑ Electricity 44❑ Yes 5 ❑ No 53. Number of bedrooms..............
38 ❑ Coal
39❑ Other — Specify Will there an elevator? Full..........
54. Number of
46 Yes 47❑ No bathrooms Partial........
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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.
SIGNATURE OF AGENT _.
ADDRESS
(NUMBER) (STREET) (CITY)
APPROVED BY TITLE
DATE 19
DEPT. FILE COPY ZO
BUILDING Ia
�.. PERMIT
- f VALIDATION
DATE ` 19 P M1 NO.
APPLICANT ADDRESS
(N0.) STREET) (CONTR'S LICENSE)
NUMBER OF
PERMIT TO (-) STORY DWELLING UNITS
(TYPE OF IMPROVEMENT) NO. (PROPOSED USE)
ZONING c
AT (LOCATION) DISTRICT
(NO.) (STREET)
a BETWEEN AND
a (CROSS STREET) (CROSS STREET)
LOT
a. SUBDIVISION LOT BLOCK SIZE
m
a
V
O BUILDING IS TO BE FT. WIDE BY FT. LONG BY FT. IN HEIGHT AND SHALL CONFORM IN CONSTRUCTION
m
Z TO TYPE USE GROUP ' BASEMENT-WALLS OR FOUNDATION
I F (TYPE)
at
IL REMARKS: t`
AREA OR t PERMIT
VOLUME ® ESTIMATED COST $ -FEE
U0IC/SQUARE FEET) _
OWNER 4 BUIL T.
ADDRESS BY
(Affidavit on reverse side of application to be completed by authorized agent of owner)