35-186 (9) 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, ancl State ZIP code Tel. No.
Owner or Lj 6
4
Lessee
Builder's
2. 74�-f t" -1,l.. 4 A , License N
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.
ISZgture of applic Address Application date
a 3
D0 N O T WRITE B E L 0 W T H I S L I N E
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 D
Permit or Approval Check Obtained Number By Permit or Approval Check Obtaaitne
ed 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
Building Fire Grading
Permit Fee $ Oz2 Live Loading
Certificate of Occupancy $ Occupancy Load
Approved by:
Drain Tile $
Plan Review Fee $
L
'TITLE
NOTES and Data — (For department use)
t
CITY OF NORTHAMPTON
OFFICE OF THE INSPECTOR OF BUILDINGS 0-s-, _1 1V
/'
212 MAIN STREET o �C 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
I• AT (LOCATION)
/'!�f p t..� D STR CT%
LOCATION (NO.) (STREET)
OF BETWEEN ��,.t f1 (CROSS STREE yL.^ AND (CROSS STREET)
BUILDING
LOT
SUBDIVISION LOT BLOCK SIZE
H
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 120 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 F-1 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)
17 ❑ Other — Specify 25 ❑ Public utility
7 ❑ Foundation only
26 ❑ School, library, other educational
B. OWNERSHIP 27 ❑ Stores, mercantile
8 Privat;(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 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 $
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 ❑ Private (septic tank, etc.) 49• Total square feet of floor area,
all floors, based on exterior
32❑ Structural steel dimensions ... .L.J. p °
33❑ Reinforced concrete H. TYPE OF WATER SUPPLY �� 7 0
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
F. PRINCIPAL TYPE OF HEATING FUEL I. TYPE OF MECHANICAL 51. Enclosed .......................
35❑ Gas Will there be central air 52. Outdoors........................
36Z Oil conditioning?
L. RESIDENTIAL BUILDINGS ONLY
37❑ Electricity 44 ❑ Yes 45 P] No 53. Number of bedrooms..............
38 ❑ Coal /
39❑ Other — Specify Will there be an elevator? 54. Number of Full..........
46 ❑ Yes 47 ❑ No bathrooms j
Partial.......
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hereby certify that the'-proposed work is authorized by the owner`of record
and l have been authorized by the owner to make this application as his A
authorized agent.
SIGNATUREIOF WGENT �.
ADDRESS
(NUMBER) (STREET) (CITY)
APPROVED `8Y TITLE
DATE 19 .
DEPARTIMIT OF BUILDING INSPECTIONS Z o DEPT. FILE COPY
M. NAM STEM NORTFI/�13N . D1060 PERMIT a°
PERMIT VALIDATION
5 - 186
7�
_ DATE Marah 23, 197 PERMIT NO. 81
APPLICANT Edwin Ma it-jaka ADDRESS (N 17 �V®� )� "tw• (CONTR'S LICENSE)
Now Residence � NUMBER OF
Ne
PERMIT TO (_) STORY RsSideal3e DWELLING UNITS 1
(TYPE OF IMPROVEMENT) NO. (PROPOSED USE)
ZONING
AT (LOCATION) B3= nab DISTRICT SH
(N0.) (STREET)
a BETWEEN Blirtf9 -Pit %Bd AND
'D (CROSS STREET) (CROSS STREET)
w_
LOT
(L SUBDIVISION LOT BLOCK SIZE
0 BUILDING IS TO BE 28 FT. WIDE BY 48 FT. LONG BY FT. IN HEIGHT AND SHALL CONFORM IN CONSTRUCTION
O
M
O
Z TO TYPE USE GROUP BASEMENT WALLS OR FOUNDATION
f (TYPE)
0:
° REMARKS: Construct one-.family residenee
Wood.frame - private �t#ge disposal - oil heat -» (4 bedrooms)
1. 1 fell bath, 1 partial
AREA OR VOLUME 344 ESTIMATED COST $ FEEMIT .� 75-00
(CUBIC/SQUARE FEET)
OWNER Edwin Mattisk
BUIL iNG P
ADDRESS 17 Graves Ave. N'ton, BY
(Affidavit on reverse side of application to be completed by authorized agent of owner)