25C-045 (6) 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.
1.
Owner or �. Ld��s ��G� G� 7 hl/o E) o11/- Q/0
Lessee �� �� 7
Bui Ider'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.
Signat" of applicant Address Application date
DO NOT WRITE BELOW THIS LINE
V. PLAN REVIEW RECORD — For office use
Plans Review Required Check Plan Review Date Plans B Date Plans B Notes
9 Fee Started y Approved y
BUILDING $
PLUMBING $
MECHANICAL $
ELECTRICAL $
OTHER Is
VI. ADDITIONAL PERMITS REQUIRED OR OTHER JURISDICTION APPROVALS
Permit or Approval Check Obta Date 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 6 n-c,C�T�� 19 w7
Building T Fire Grading
Permit Fee $��- /1%� Live Loading
Certificate of Occupancy $ Occupancy Load
Approved by:
Drain Tile $
Plan Review Fee $ r
_. T-
NOTES and Data — (For department use)
CITY OF NORTHAMPTON
OFFICE OF THE INSPECTOR OF BUILDINGS
212 MAIN STREET APPLICATION FOR
NORTHAMPTON, MA. 01060 PLAN EXAMINATION AND
BUILDING PERMIT
z
IMPORTANT — Applicant to complete all items in sections: 1, 11, III, IV, and IX. O
ZONING
I• AT (LOCATION) / l7 f-° =-^-' DISTRICT
LOCATION (NO'.) (STREET)
OF BETWEEN AND
BUILDING (CROSS STREET) (CROSS STREET)
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 1 One family 18 ❑ Amusement, recreational
of new bousing units added, if any,
in Part D, 13) 13 Two or more family — Enter 19 ❑ Church, other religious
number of units— — — — --> 20 Industrial r
3 ❑ Alteration (See 2 above)
14 ❑ Transient hotel, motel, 21 ❑ Parking garage
4 ❑ Repair, replacement or dormitory — Enter number
o units ——————— — --� 22 ❑ Service station, repair garage
5 ❑ Wrecking (if multifamily residential, f _ ,
enter number of units in building in 1Gorage 23 Hospital, institutional Ce
Part D, 13)
16 Carport 24❑ Office, bank, professional
6 ❑ Moving (relocation)
17 ❑ Other — SpeciJy 25 ❑ Public utility
7 ❑ Foundation only
�
- //�/ 26 ❑ School, library, other educational
�f�
B. OWNERSHIP 12 d.tii-.L' -1 27 ❑ Stores, mercantile
8 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,,,,,••,•,,...., pc ty, 6Cl 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) 400 Public or private company 48• Number of stories................
49. Total square feet floor area,
31 Wood frame 41 ❑ Private (septic tank, etc.)
all floors, based on exterior
32 ructural steel dimensions .....................
33❑ /1-91 Reinforced concrete H. TYPE OF WATER SUPPLY , ll;
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
51. Enclosed ......................
F. PRINCIPAL TYPE OF HEATING FUEL I. TYPE OF MECHANICAL
35 ❑ Gas Will there be central air 52. Outdoors........................
36 ❑ Oil 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? 54. Number of Full..........
46 ❑ Yes 47 ❑ No bathrooms
Partial.......
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 applications :as his `
authorized agent.
_
SIGNATURE OF AGENT
ADDRESS
(NUMBER) (STREET)
APPROVED BY TITLE
DATE 19
'f _
DEPARTNENT OF BUILDING INSPECTIONS Z Q DEPT. FILE COPY
212 MAIN STREET 04
IL
'NORTHAMPTON, MA.. 01060 BUILDING a
PERMIT VALIDATION
25C - 45
DATE_Ajril 1, 19 -79 PERMIT NO. 1_23.
APPLICANT Dwi&t Church ADDRESS 17 Woodbine Ave.
(NO.) (STREET) (CONTR'S LICENSE)
NUMBER OF
PERMIT TO A_dditiOn .+ *9-7'Rge (�) STORY QBI� _Ce — residential. DWELLING UNITS 1
(TYPE OF IMPROVEMENT) NO. (PROPOSED USE)
AT (LOCATION)
17 Woodbine Ave. D STN cT URB
(N0.) (STREET)
a BETWEEN AND
b (CROSS STREET) (CROSS STREET)
P
LOT
4 SUBDIVISION LOT BLOCK SIZE
m
a Addition
U0 .0 yXOYM IS TO BE 12 FT. WIDE BY 32 FT. LONG BY FT. IN HEIGHT AND SHALL CONFORM IN CONSTRUCTION
m
O
Z TO TYPE USE GROUP BASEMENT WALLS OR FOUNDATION
(TYPE)
tr
LL O REMARKS: Ajdj tion to axistina detac-bed $aLrag$-pP_r aM1'lCatJOn
AREA OR PERMIT
VOLUME ESTIMATED COST $ TOCQ FEE 10.00
(CUBIC/SQUARE FEET)
OWNER Di4ght Chumb BUI ING EPT.
ADDRESS 17 Woodbine Ave N'ton. BY
(Affidavit on reverse side of application to be completed by authorized agent of owner)