36-166 (6) VIII. ZONING PLAN EXAMINERS NOTES
DISTRICT
USE
FRONT YARD
SIDE YARD SIDE YARD
REAR YARD
NOTES
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BOCA FORM APEBP - 669 C1969 BUILDING OFFICIALS & CODE ADMINISTRATORS INTERNATIONAL, INC.
IV. IDENTIFICATION — To be completed by all applicants
P Name Mailing address — Number, street, city, and State ZIP code Tel. No.
Owner or >c� 1 C)'C C .�
Lessee
Bui 2. [h c PPh� tJ 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.
igna ure of applicant Address Application date
0 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
Permit or A rova I Check Date Date
Number y Permit or Approval Check Obtained Number By
PP Obtained er
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
Permit Fee $ Live Loading
Occupancy Load
Certificate of Occupancy
Ap d by:
Drain Tile /
Plan Review Fee
TITLE
NOTES and Data — (For department use)
C
CITY OF NORTHAMPTON
OFFICE OF THE INSPECTOR OF BUILDINGS
212 MAIN STREET APPLICATION FOR
NORTHAMPTON, MA. 01060 PLAN EXAMINATION AND
BUILDING PERMIT
IMPORTANT — Applicant to complete all items in sections: 1, 11, 111, IV, and IX. O
ZONING
• AT (LOCATION) 6/rs>)C DISTRICT
LOCATION J (N0.) (STREET)
OF BETWEEN AND
BUILDING (CROSS STREET) (CROSS STREET)
LOT
SUBDIVISION LOT BLOCK SIZE
V1
II. TYPE AND COST OF BUILDING — All applicants complete Parts A — D
A. TYPE OF IMPROVEMENT D. PROPOSED USE — For"Wrecking" most recent use Im
M
1 ❑ New building Residen ' I Nonresidential
2 F-1 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
3 Alteration (See 2 above) number of units— — — — -•>. 20 ❑ Industrial
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 C rport 24❑ Office, bank, professional
6 ❑ Moving (relocation) ])
17 Other — Specify ���✓ ��,f�-1Y 25 ❑ Public utility
7 ❑ Foundation only
26 ❑ School, library, other educational
B. O721i .te IP 27 ❑ Stores, mercantile
8 (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•••••••,•,...... OCT, 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 1$
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❑ M sonry (wall bearing) 40 F-1 Public or private company 48• Number of stories...............
31 good frame 41 ❑ 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 Will there be central air 52. Outdoors........................
conditioning?
36 ❑ Oil / L. RESIDENTIAL BUILDINGS ONLY
37 F—] Electricity 44 ❑ Yes 45 No 53. Number of bedrooms.....
38 ❑ Coal
39❑ Other — Specify f kQ NJ Will there be an elevator? Full...��.....
54. Number of
46 ❑ Yes 47 bathrooms
Partial.Q...
F � kT� �tl,a dry
5✓4� .�6.�. C
till
s
CEATIFlWk !$SUEf:I,
NC
t;
x, •.' ;- .. DATE t9 PERtAIT NC.
J '41A1kTr�air ADORES
;fe9 1t`8, LICXKSSI;:
r
art,:
S f 1 ST,fty St
,� � $� tlTl NQ, i'P8QPC5Rp U�El
I G
e
m CIylsl", La 66:4 slz
t
0 1 + 1 V, ._. Fr. Wtof By FT. toho BY —,-fir. IN HEtr .ar rsue« Ca .anM rca ilcr
Z Tb 6 E 'USE GROUP BASEMENT WALLS OR Fat?ttlQA710M
a4AKS: ..
A(RI aR'
V air# lE
tCIMClsqJJAaeE rsert
SEE
r�
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 c c
ADDRESS
(NUMBER) (STREET) (CITY)
APPROVED BY T17LE
DATE 19
DEPT. FILE COPY
DEPARTA0ff OF BUILDING INSPECTIONS Zo
212 MAIN STREET BUILDING
VORTHAMPTON, MA. 01060 PERMIT R MM
• IT VALIDATION
36 - 166
DATE Tilly 11_____19 79 PERMIT NO. 3,t6
APPLICANT John E irplay ADDRESS 773 Florence Rd.
(NO.) (STREET) (CONTR'S LICENSE)
NUMBER OF 1
PERMIT TO Alter residence (—j—) STORY Sun room DWELLING UNITS
(TYPE OF IMPROVEMENT) NO. (PROPOSED USE)
ZONING
AT (LOCATION) Florence Road — DISTRICT SR
OP (STREET)
rn BETWEEN AND
10 (CROSS STREET) (CROSS STREET)
O�
LOT
a. SUBDIVISION LOT BLOCK SIZE
m
a
v BUILDING IS TO BE FT. WIDE BY FT. LONG BY FT. IN HEIGHT AND SHALL CONFORM IN CONSTRUCTION
O
m
Z TO TYPE USE GROUP BASEMENT WALLS OR FOUNDATION
� (TYPE)
K
REMARKS: sc-reen in existing am deck, add roof for suumer use
AREA OR FEEMIT � 10.00
VOLUME ESTIMATED COST
(CUBIC/SQUARE FEET)
OWNER R1ts E. 1413MhY BU( I
ADDRESS 773 Florence Rd., Florence, Ma. 01060 BY
(Affidavit on reverse side of application to be completed by authorized agent of owner)