36-193 (4) VIII. ZONING PLAN EXAMINERS NOTES
DISTRICT
USE a ;�
FRONT YARD
SIDE YARD SIDE YARD
REAR YARD
NOTES
IX. SITE OR PLOT PLAN — For Applicant Use
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'ORM 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.
r
Owner or
Lessee
L G 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
L(,t..�.sG;Zc �,1,,,rtiv� l�.�� !✓" tiC.. S_�`l 7�.
DO 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 Is
OTHER Is
VI. ADDITIONAL PERMITS REQUIRED OR OTHER JURISDICTION APPROVALS
Date Date
Permit or Approval Check Obta ned 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 number
Building ^ Use Group
Permit issued l 197
Building
Grading
Permit Fee �/� Live Loading
Certificate of Occupancy $ Occupancy Load
Approved by:
Drain Tile $
Plan Review Fee $
MEW/
NOTES and Data — (For department use)
2- X -
rj
CITY OF NORTHAMPTON
OFFICE OF THE INSPECTOR OF BUILDINGS
212 MAIN STREET APPLICATION FOR
NORTHAMPTON, MA. 01060 PLAN EXAMINATION AND
` ?•° f' rr. BUILDING PERMIT
IMPORTANT — Applicant to complete all items in sections: 1, 11, 111, IV, and IX. O
• `'
AT (LOCATION) Ik�• DISTRICT
LOCATION (No.) i (STREET) [j
OF BETWEEN - /'�' '+'L-L<, AND i13I
BUILDING (CROSS STREET) (CROSS STREET)
Y
SUBDIVISION LOT BLOCK SIZE C �i P
N
II. TYPE AND COST OF BUILDIN 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 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
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, J urt -- P 9 9
enter number of units in building in 15?10?C(arpnorts
23 ❑ Hospital, institutional sr
Part D, 13) 16 24❑ Office, bank, professional
6 Moving (relocation)
7 � Foundation only 17 ❑ Other — Specify 25 ❑ Public utility
26 ❑ School, library, other educational
B. OWNERSHIP 27 ❑ Stores, mercantile
8 r� 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 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 $ 6
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 .�r .� .X..� -..
33 ❑ Reinforced concrete H. TYPE OF WATER SUPPLY
34 F-1 Other — Specify 42 Public or private company 50. Total land area, sq. fT. ........... mac- r 7
43 ❑ Private (well, cistern) K. NUMBER OF OFF-STREET
PARKING SPACES
51. Enclosed ....................... j
F. PRINCIPAL TYPE OF HEATING FUEL I. TYPE OF MECHANICAL
35 ❑ Gas Will there be central air 52. Outdoors........................ Z
36 [00iI conditioning? L. RESIDENTIAL BUILDINGS ONLY
37 ❑ Electricity 44 ❑ Yes 45 [P�No 53. Number of bedrooms..............
38 ❑ Coo I
39❑ Other — Specify Will there be an elevator? Full..........
54. Number of
46 ❑ Yes 47 hNo bathrooms
Partial.......
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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 ti
z
DATE 19
DEP.ARTV= OF BUILDING INSPECTIONS DEPT. FILE COPY
_ STREET zD
NORTHADTTON, MA. 01060 BUILDING <a
36 _. 9 ■6 ERMI ■ VALIDATION
DATE May 14, 19 7_ PERMIT NO. 203
APPLICANT rMArAnrp TnTeme __ ADDRESS RRl Whittier + _T N'ton.
(NO.) (STREET) -- (CONTR'S LICENSE)
NUMBER OF
PERMIT TO New Rp.Ri denoe (_2_) STORY RP4i dente DWELLING UNITS 1
(TYPE OF IMPROVEMENT) NO. (PROPOSED USE)
AT (LOCATION)
arts Pit Road Lot i10 DISTRICT
(NO.) (STREET)
a BETWEEN Pl orenne Rr3 AND P r ons Rrook
m (CROSS STREET) (CROSS STREET)
LOT
0
m SUBDIVISION LOT 10 BLOCK SIZE 30,387
V
O BUILDING IS TO BE 32 WIDE BY 24 FT. LONG BY FT. IN HEIGHT AND SHALL CONFORM IN CONSTRUCTION
to
O
Z TO TYPE USE GROUP BASEMENT WALLS OR FOUNDATION
E (TYPE)
Ix
L� REMARKS: Construct nnP family residenoe '
AREA OR 1' 28 PERMIT
VOLUME i44o ESTIMATED COST $ ,000 FEE 8+•00
(CUBIC/SQUARE FEET)
OWNER Thpnrinrp TnTrnp f
ADDRESS RRl Whittier er St NI tOn } Ma BYI IN D PT.
tih
(Affidavit on reverse side of application to be completed by authorized agent of owner)