25C-143 (4) VIII. ZONING PLAN EXAMINERS NOTES
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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
IIJJ G Builder's
2.
License No.
Contractor
s
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
00 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
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 19 Use Group
Permit issued
Building Fire Grading
Permit Fee $ lU �� Live Loading
Certificate of Occupancy $ Occupancy Load
Approved by:
Drain Tile $ -�
Plan Review Fee $
TITLE
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, 111, IV, and IX. O
�rtl y1 J ZONING
I AT (LOCATION) "��• • f O / DISTRICT
LOCATION (NO.) (STREET)
OF BETWEEN AND
BUILDING (CROSS STREET) (CROSS STREET)
LOT
SUBDIVISION LOT BLOCK SIZE
Vr
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 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 (1l multifamily residential, of units ——————— —
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 — Specify 25 ❑ Public utility
7 ❑ Foundation only
26 ❑ School, library, other educational
B. OWNERSHIP C"""` 27 ❑ Stores, mercantile
j 'r 28 ❑ Tanks, towers
8 Private (individual, corporation, _ �(' 3 u — V 29 Other — Specify
nonprofit institution, etc.) ❑ p fy
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,,,,,,,,,,,,,,,, s 234it; 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 $ J-3.;J
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 �L
30❑Masonry (wall bearing) 40 [A Public or private company 48• Number of stories...............
31 X Wood 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 ❑ Other — Specify 42 Q 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 KGos 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.......
4 l
1, hereby_certify.that the proposed work is authorized by the owner of record
and 1 have been authorized by the owner to niak6 this application gas- has
authorized agent.
SIGNATURE O� AGENT
ADDRESS
(NUMBER) (STREET) (CITY)
APPROVED BY TITLE
DATE 19
t
DEPAMWEN7 OF BUILDING INSPECTIONS DEPT. FILE COPY
212 MAIN STREET o a
NOEVrH MP`I:ON MA, 01060 BUILDING <a
25C • 143 CODE #79 PERMIT VALIDATION
DATE March 4, 19 80 NO. 121
APPLICANT Ftnegx. Phola- Jr. ADDRESS RFD Z Soy Ltonl, 31t-
(NO,) (STREET) (CONTR'S LICENSE)
NUMBER OF
PERMIT TO (�_) STORY DWELLING UNITS Z
(TYPE OF I ROVE ENT) N0. (PROPO 0 USE)
ZONING
AT (LOCATION) 399_41, Orchard DISTRICT URB
(NO.) (STREET)
BETWEEN AND
(CROSS STREET) (CROSS STREET)
LOT
SUBDIVISION LOT BLOCK SIZE
i BUILDING IS TO BE 2 FT. WIDE BY 30 FT. LONG BY FT. IN HEIGHT AND SHALL CONFORM IN CONSTRUCTION
I
TO TYPE USE GROUP BASEMENT WALLS OR FOUNDATION
(TYPE)
-' REMARKS: Construct detached garage
AREA OR
VOLUME ESTIMATED COST $ 2300.00 FEEMIT $ 10-n0
(CUBIC/SQUARE FEET)
OWNER Ernest Phelps, Jr.
ADDRESS 39 • 41 Orchard Street, N'ton. BY D P
(Affidavit on reverse side of application to be completed by authorized agent of owner)