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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
.r - t� r.,� Builder's
2. J31A RvG r e r� 6-yo L c M t ( C 5 Q Q License No. l)
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 licant Address Application date
.7 s �d
D0 NOT WRITE BELOW THIS LINE
V. PLAN REVIEW RECORD — For office use
Plans Review Required Check PlanFeeview DSt Plans By Date Plans By Notes
BUILDING
PLUMBING
MECHANICAL
ELECTRICAL
OTHER
VI. ADDITIONAL PERMITS REQUIRED OR OTHER JURISDICTION APPROVALS
Approval Check Number B Date umer Permit or Approval I Check N
Dote
Permit or A umber 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
Building Fire Grading
Permit Fee $ `y�� Live Loading
Occupancy Load
Certificate of Occupancy
Appr ed by:
Drain Tile $ �
Plan Review Fee
C�a 5
TITLE
NOTES and Data — (For department use)
CITY OF NORTHAMPTON
OFFICE OF THE INSPECTOR OF BUILDINGS
212 MAIN STREET APPLICATION FOR
NORTHAMPTON, MA. 01060 3,6 _78 PLAN EXAMINATION AND
BUILDING PERMIT
z
IMPORTANT — Applicant to complete all items in sections: 1, 11, 111, IV, and IX. O
"�" �y ZONING
I• AT (LOCATION) .31/0 We-t-tAA'Y'A1artNn SY: _ DISTRICT
LOCATION �►-1j(NO.) (STRE T) / y� J^ /�/I
OF BETWEEN �`OrC,V1C.°t, e) AND we5 /—QYY11 X
BUILDING (CROSS STREET) (CROSS STREET)
LOT
SUBDIVISION LOT BLOCK SIZE
N
Ill. TYPE AND COST OF BUILDING — All applicants complete Parts A — D
A. TYPE OF IMPROVEMENT D. PROPOSED USE — For"Wrecking" most recent use rn
rn
1 ❑ New building Residential Nonresidential
2 IWAddition(If residential, enter number 12 ROne 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)
17 ❑ Other — SpeciJy 25 ❑ Public utility
7 ❑ Foundation only
�
bb 26 ❑ School, library, other educational
B. OWNERSHIP 0 {.Sftlf_ $�QcV (,IJR_V 27 ❑ Stores, mercantile
8 Private (individual, corporation, L 28 ❑ Tanks, towers
nonprofit institution, etc.) r;2vJ eq YCs 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................ C✓ 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 49• Number u stories...... area, ..
31�Wood frame 41�rivate (septic tank, etc.) 49. Total square feet n floor area,
all floors, based on exterior
32 ❑ Structural steel dimensions .....................
33 ❑ Reinforced concrete H. TYPE OF WATER SUPPLY
34 ❑ Other — Specify 42 ❑ Public or private company 50. Total land area, sq. ft. ...........
43 1�rivote (well, cistern) K. NUMBER OF OFF-STREET
PARKING SPACES
51. Enclosed ......................
F. PRINCIPAL TYPE OF HEATING FUEL I. TYPE OF MECHANICAL
35 ❑ Gas Will there be central air 52. Outdoors........................
36 00i I conditioning?
L. RESIDENTIAL BUILDINGS ONLY
37 ❑ Electricity 44❑ Yes 450 53. Number of bedrooms..............
38 ❑ Coal
39❑ Other — Specify Will there be an elevator?❑ j
Full..........
$�� 54. Number of
46 Yes 47 j!N No bathrooms partial........
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