35-187 (5) 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
Lessee
f S�
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
7iF
/ 00 NOT WRITE BELOW 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 $
VI. ADDITIONAL PERMITS REQUIRED OR OTHER JURISDICTION APPROVALS
Dote 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
V11. VALIDATION
Building FOR DEPARTMENT USE ONLY
Permit number =S
Building ++ Use Group
Permit issued � �� r 19
�
Building Fire Grading
Permit Fee $ �• Live Loading
Certificate of Occupancy $ Occupancy Load
A ed by:
Drain Tile $ '0
Plan Review Fee $
TITLE
NOTES and Data — (For department use)
C14A4
CITY OF NORTHAMPTON
OFFICE OF THE INSPECTOR OF BUILDINGS
212 MAIN STREET APPLICATION FOR
NORTHAMPTON, MA. 01060 3 ( F 7 PLAN EXAMINATION AND
BUILDING PERMIT
IMPORTANT — Applicant to complete all items in sections: 1, It, 111, IV, and IX. O
ONINGS�
Z \\qq
AT (LOCATION) '+'� / � � DISTRICT
LOCATION (NO.) (STREET)
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
M
1 ❑ New building Residential Nonresidential
2 XAddition(If residential, enter number 12 NJ 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 F-1 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 F-1 Foundation only 17 Other — Specify 25 ❑ Public utility
26 ❑ School, library, other educational
B. OWNERSHIP 27 ❑ Stores, mercantile
8 Private (individual, corporation,
28 ❑ Tanks, towers
nonprofit institution, etc.) i 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.)..............
i
11. TOTAL COST OF IMPROVEMENT Is
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 rj Private (septic tank, etc.) 49• Total square feet of floor area,
all floors, based on exterior
32❑ Structural steel dimensions .....................
33 ❑ Reinforced concrete H. TYPE OF WATER SUPPLY
34 F-1 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 ill there be central air , 52. Outdoors........................
36 Oil con Wing?
�" L. RESIDENTIAL BUILDINGS ONLY 3
37❑ Electricity 44 ❑ Yes ` 45 ❑ No 53. Number of bedrooms..............
38 ❑ Coo I J
39❑ Other — Specify Will t e be an elevator? �'� Full...{......
54. Number of
Yes 47❑ No bathrooms
Partial.......
hereby cer`tlfy that the proposed work is authorized by the owner of'record '
and I have been authorized by 'the owner tocmokec#hi application°. as his.
authorized agent.
SIGNATURE '6F~AGENT-
ADDRESS
(NUMBER) (STREET) _ _ (CITY)
APPROVED BY TITLE
DATE 19
DEPART' OF BUIDDING INSPECTIONS Z DEPT. FILE COPY
�
No3RTHAmpTGNT,MMAA. 01060 BUILDING
35 - 187 Code # 79 PERMIT VALIDATION
DATE September 140 1979 PERMIT NO.
APPLICANT Marine An+ji7A ADDRESS 6t Vah111=e Terrace
(N0.) (STREET) (CONTR'S LICENSE)
NUMBER OF
PERMIT TO ChimnaV & wood. ato3m ( '�_) STORY fnr Mond-I91irni1_ng 8'toye DWELLING UNITS
(TYPE F IMPROVEMENT) NO. (PROPOSED USE)
ZONING SR
AT (LOCATION) 6j Ca illane TerrBOe DISTRICT
(NO.) (STREET)
BETWEEN AND (
w (CROSS STREET) CROSS STREET)
LOT
ma SUBDIVISION LOT BLOCK SIZE
a
O
O BUILDING IS TO BE FT. WIDE BY FT. LONG BY FT. IN HEIGHT AND SHALL CONFORM IN CONSTRUCTION
GO
O
Z TO TYPE USE GROUP BASEMENT WALLS OR FOUNDATION
(TYPE)
D:
�o REMARKS: Construoti blook ohimeY and wood burning stove installation
AREA OR PERMIT 10
VOLUME ESTIMATED COST $ FEE
(CUBIC/SQUARE FEET)
OWNER Mard n Apri Ia B DIN
ADDRESS 61 Cahi ane TE3rraaB Nort -Omp-ton, Ma.
(Affidavit on reverse side of application to be completed by authorized agent of owner)
IIIIIIIIIIIIIIIIF