25C-258 (5) 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 APESP — 669 01969 BUILDING OFFICIALS & CODE ADMINISTRATORS INTERNATIONAL, INC.
IV. IDENTIFICATION – To be completed by all applicants
Name Mailing address — Number, strut, city, and State ZIP code Tel. No.
1. 7 -
Owner or
Lessee
Builder's
2 \c` 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
00 NOT WRITE BELOW THIS LINE
V. PLAN REVIEW RECORD – For office use
Plan Review Date Plans Date Plans
Plans Review Required Check Fee Started By Approved By Notes
BUILDING $
PLUMBING $
MECHANICAL $
ELECTRICAL $
OTHER $
VI. ADDITIONAL PERMITS REQUIRED OR OTHER JURISDICTION APPROVALS
Permit or A rova I Check Date Number B Permit or Approval Check Date Number B
PP Obtained y Obtained y
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 f FOR DEPARTMENT USE ONLY
Permit number 7
Building Use Group
Permit issued { /T-1971,
Fire Grading
Building
Permit Fee Live Loading
Occupancy Load
Certificate of Occupancy $
Approved by:
Drain Tile $ -
Plan Review Fee
- LE
NOTES and Data — (For department use)
141'C
l / �r i c.
T
�' �- r. _ /,)-I
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
ZONING Zj
I• AT (LOCATION) ZE C_(I' = 7�1 C(� ! D STR C ,�
LOCATION (N0.) (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 -Reside ial Nonresidential
2 F__1 Addition(If residential, enter number 12 �One family 18 ❑ Amusement, recreational
i new housing units added, if any, 13 ❑ Two or more family — Enter 19 ❑ Church, other religious
i Part D, 13) number of units— — —7 -�
3 Alteration (See 2 above) 20 ❑ Industrial
14 ❑ Transient hotel, motel, 21 ❑ Parking garage
4 ❑ Repair, replacement or dormitory — Enter number 22 Service station, repair garage
5 ❑ Wrecking (If multifamily residential, of units ——————— — -i P 9 9
enter number of units in building in 15 ❑ Garage 23 ❑ Hospital, institutional
Part D, 13) ❑
16 Carport 24 E] Office, bank, professional
6 ❑ Moving (relocation)
7 ❑ Foundation only 17 F-1 Other — Specify 25 E] Public utility
26 ❑ School, library, other educational
B. OWNERSHIP 27 ❑ Stores, mercantile
8 EOIP,ivate (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.)............ J
11. TOTAL COST OF IMPROVEMENT $ / Ge
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 feat 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........................
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 application as his
authorized agent.
SIGNATURE OF AGENT _.` . .
ADDRESS
(NUMBER) (STREET) (CITY)
APPROVED BY TITLE
DATE 19
F DEPT. FILE COPY
Zo
"'EPT. OF BUILDING INSPECTIONS BUILDING 2a
212 Main Street 25C ^ 258 PERMIT
Normpwn."___ Q1 VALIDATION
t�
DATE Ontaher 10, 197_ PERMIT NO._ 476
APPLICANT_ Dnr-tg ._ otainaki ADDRESS Fair
(N0.) (STREET) (CONTR'S LICENSE)
NUMBE OF
PERMIT TO Alter Rpaidenee (om) STORY Residence DWELLING UNITS
(TYPE OF IMPROVEMENT) N0. -(PROPOSED USE)
11 Fair ZONING URA
AT (LOCATION) DISTRICT
(NO.) (STREET)
a BETWEEN AND
m
a (CROSS STREET) (CROSS STREET(
0, LOT
m SUBDIVISION LOT BLOCK SIZE
a
U BUILDING IS TO BE FT. WIDE BY FT. LONG BY FT. IN HEIGHT AND SHALL CONFORM IN CONSTRUCTION
m
O
Z TO TYPE USE GROUP BASEMENT WALLS OR FOUNDATION
x
R (TYPE)
0 REMARKS: Add nindprblonk objrrintay, remove two windows and replace with a b&,y window,
knock out wall to enlarge living room, insulation, other misc. alterations.
AREA OR PERMIT
VOLUME ESTIMATED COST $ 1700.00 FEE $_1 .00
(CUBIC/50 DARE FEET)
OWNER Latin ja81ngki _
ADDRESS 1.1 FA3r gtreet, N rtbaMton, Ma- B LDI DEPT
B
(Affidavit on reverse side of application to be completed by authorized agent of owner)