35-200 (4) 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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BOLA FORM APEBP — 669 01969 BUILDING OFFICIALS & CODE ADMINISTRATORS INTERNATIONAL, INC.
IV. IDENTIFICATION — To be completed by all applicants
Name// Mailing address — Number, strut, 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.
Si ature of Opplica fi Address Application date
D0 NOT WRITE BELOW THIS LINE
V. PLAN REVIEW RECORD — For office use
Plan Review Date Plans B Date Plans
Plans Review Required Check Fee Started y Approved BY Notes
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 numbers
Building D Use Group
Permit issued 19 —
�— Fire Grading
Building
Permit Fee $ o ate Live Loading
Occupancy Load
Certificate of Occupancy $
Approved by:
Drain Tile $
Plan Review Fee $
TLE
NOTES and Data — (For department use)
y �
q
-1
CITY OF NORTHAMPTON
OFFICE OF THE INSPECTOR OF BUILDINGS l
212 MAIN STREET %`f 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
• AT (LOCATION) L � D STR CT<
LOCATION IN 0.) (STRE T)
OF BETWEEN 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
--I
1 ❑ New building Re dia[ Nonresidential
2
Addition(If residential, enter number 1 JCI Oentne family 18 ❑ Amusement, recreational
of new bousing 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
_—————— — — 22 ❑ Service station, repair garage
5 ❑ Wrecking (If multifamily residential, , of units �
enter number of units in building in i 5_X Garage 23 ❑ Hospital, institutional
Part D, 13) 16 Carport 24❑ Office, bank, professional
6 ❑ Moving (relocation) 25 ❑ Public utility
17 Other — SpeciJ
7 ❑ Foundation only
26 ❑ School, library, other educational
B. OWNERSHIP 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................ school, secondary school, college, parochial school, parking garage for,
department store, rental office building, office building of 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
48. Number of stories.... ••........
31 Wood (wall bearing) 40 ❑ Public or private company
/trj�C�r 49. Total square feet of floor area,
31 Wood frame 41 Private (septic tank, etc.) all floors, base e t rior
32 ❑ Structural steel dimensions , Pf�••
33 ❑ Reinforced concrete H. T PE OF WATER SUPPLY '�/t�v
42 Public or rivate com an 5 Toto+lgl'dnd era, sq
34❑ Other — Specify p p 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........................
�y v
36❑ Oil conditioning? L. RESIDENTIAL BUILDINGS ONLY
37❑ Electricity 44 ❑ Yes 454 No 53. Number of bedrooms..............
38 ❑ Coal
39❑ Other — Specify Full..........
Will there be an elevator?, Number of
46 ❑j Yes 47A No bathrooms Partial........
I 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
DEPART= OF BUILDING INSPECTIONS zo
n-
r 212 MAIN STREET BUILDING Qa
NORMAMPTON, MA.. 01060 I
PERMT{V1 VALIDATION
35 - 200
DATE May 2+ 19 79 PERMIT NO. 174
APPLICANT Raymond Johnson ADDRESS 11 T)]rkey Hi 1] Rng(i
(NO.) (STREET) (CONTR'S LICENSE)
NUMBER OF
PERMIT TO Garage & breezeway ( ) STORY Residential DWELLING UNITS 1
(TYPE OF IMPROVEMENT) NO. (PROPOSED USE)
ZONING �R
AT (LOCATION) 11 Turkey Hill Rd, DISTRICT
(NO.) (STREET)
rn BETWEEN AND
m (CROSS STREET) (CROSS STREET)
LOT
CL SUBDIVISION LOT BLOCK SIZE
aBreezway 1p0 14
U BUILDING IS TO BE 18 FT. WIDE BY 24 FT. LONG BY FT. IN HEIGHT AND SHALL CONFORM IN CONSTRUCTION
m
Z TO TYPE USE GROUP BASEMENT WALLS OR FOUNDATION
(TYPE)
LL E
REMARKS: OonStruct 1-car garage and breezeway -
AREA OR
PERMIT
VOLUME ESTIMATED COST � 3,000 FEE 10.00
(CUBIC/SQUARE FEET)
OWNER Ravmond 8c Marianne Johnson BuiL ING T. A 9,z,.Aj
ADDRESS 11 '),rkPy Hi l l Ra N tan BY
(Affidavit on reverse side of application to be completed by autho7ed en t of owner)