25A-157 (8) 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 01969 BUILDING OFFICIALS & CODE ADMINISTRATORS INTERNATIONAL, INr / t
IV. IDENTIFICATION — To be completed by all applicants
Name Mailing address — Nranber, strut, city, arx(State ZIP code Tel. No.
Owner or Xk4_ V f
Lessee
®' I ,� Builder's
2. '� ,Qjy� 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.
Signs re f ap I C Address Applic ti on ate
DO NOT WRITE BELOW THIS LINE
V. PLAN REVIEW RECORD — For office use
Plans Review Required Check Plan Review Date Plans B Date Plans
Fee Started y Approved By Notes
BUILDING
PLUMBING
MECHANICAL
ELECTRICAL
OTHER
VI. ADDITIONAL PERMITS REQUIRED OR OTHER JURISDICTION APPROVALS
Date
Permit or Approval Check —Obtained Number By Permit or Approval Check Date 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 //���„�9, 19&
Building Fire Grading
Permit Fee $ ��
Live Loading
Certificate of Occupancy $ Occupancy Load
Approved by:
Drain Tile
Plan Review Fee
ITLE
NOTES and Data — (For department use)
t
4;
1
APPLICATION FOR
S PLAN EXAMINATION AND
BUILDING PERMIT
IMPORTANT — Applicant to complete all items in sections: 1, 11, 111, IV, and IX. O
I.
AT (LOCATION) ✓ � �) D ON
LOCATION �(NO.) (STREET)
OF BETWEEN AND
BUILDING (CROSS STREET) (CROSS STREET)
LOT
SUBDIVISION LOT BLOCK SIZE
N
11. TYPE AND COST OF'BUILDING — A11 applicants complete Parts A — D
A. TYPE OF IMPROVEMENT D. PROPOSED USE — For"Wrecking" most recent use m
M
1 ew building Re sid tial Nonresidential
2 Addition(If residential, enter number 12 VI 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
5 ❑ Wrecking (If multifamily residential, o/ nits ——————— — —)� 22 ❑ Service station, repair garage
enter number of units in building in 15 ❑ orage 23 ❑ Hospital, institutional
Par D, 13) 16 Car ort 24 ❑ Office, bank, professional
6 F-1 Movi ng (relocation) p 'r
17 ❑ Other — Specify 25 ❑ Public utility
7 F—] Foundation only � 26 ❑ School, library, other educational
B. OWN SHIP ,Z,/: �( �.cY�; 27 ❑ Stores, mercantile
8 Private (individual, corporation,
28 ❑ Tanks, towers
nonprofit institution, etc.) z 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
OJ 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 $ C3
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 asonry (wall beoring) 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 W
32 ❑
Structural dimensions ..................... '
33 ❑ Reinforced concrete H. TYPE OF WATER SUPPLY
34 ❑ Other — Specify 42,;X Public or private company 50. Total land area, sq. ft. ...........
4 ❑ 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........................
36 ❑ CiI conditioning?
L. RESIDENTIAL BUILDINGS ONLY
37❑ Electricity 44 ❑ Yes 45 ❑ No 53. Number of bedrooms..............
38 ❑ Coal
39❑ Other — Specify Will there be an elevator? Full..........
54. Number of
46 ❑ Yes 47 ❑ No bathrooms
Partial.......
Department of Building Inspections
BUILDING /
212.Main Street z d- ��� `� r/
O<
Northampton, Ma. 01060 PERMIT fa
a
25A - 157 VALIDATION
DATE 113nD 127 19 Al PERMIT NO._ 286
APPLICANT Cherles W. Draggy ADDRESS
(N0. STREET) (CONTR'S LICENSE)
PERMIT TO Addition ( 1 ) STORY_ Carport - storage NUMBER OF 1
(TYPE OF IMPROVEMENT) NO. (PROPOSED USE) DWELLING UNITS _..
AT (LOCATION) 234 North ZONING DISTRICT URB
(NO.) (STREET)
BETWEEN AND
(CROSS STREET) (CROSS STREET)
LOT
SUBDIVISION LOT BLOCK SIZE
BUILDING IS TO BE 12 FT. WIDE BY 24 FT. LONG BY FT. IN HEIGHT AND SHALL CONFORM IN CONSTRUCTION
TO TYPE USE GROUP BASEMENT WALLS OR FOUNDATION
(TYPE)
REMARKS: Addi tine of carport to Pxisting barn
AREA OR
VOLUME ESTIMATED COST $ _ FEEMIT 1 0
(CUBIC/SQUARE FEET)
OWNER _ Charles W. Dragon
ADDRESS 234 North Street, Northampton, Ma. 01060 BYl ING P, .
er-
WHITE - FILE COPY . GREEN - FIELD COPY ■ CANARY - APPLICANT PINK - ASSESSORS COPY