31B-035 (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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io4wo-6466ilo 4_"—1-4i ii
6 ill BOCA FORM APEBP — 669 01969 BUILDING OFFICIALS & CODE ADMINISTRATORS INTERNATIONAL, INC.
I
IV. IDENTIFICATION — To be completed by all applicants
Name Mailing address — Number, street, city, and State ZIP code Tel. No.
L
tl �! � Q`
Owner or , l,C
Lessee
C
Builder's
2.
License No.
Contractor
3. ..
Architect or
s
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_ Add/ress y i 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
V1. ADDITIONAL PERMITS REQUIRED OR OTHER JURISDICTION APPROVALS
Date Date
Permit or Approval Check Obtained 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 _ 19
Building � ! Fire Grading
Permit Fee . //Z"?, G� Live Loading
Certificate of Occupancy $ Occupancy Load
Approved by:
Drain Tile
Plan Review Fee
�_... T I TL-F-
L
NOTES and Data — (For department use)
I
CITY OF NORTHAMPTON
OFFICE OF THE INSPECTOR OF BUILDINGS -�
212 MAIN STREET APPLICATION FOR
NORTHAMPTON, MA. 01060 PLAN EXAMINATION AND
BUILDING PERMIT
IMPORTANT — Applicant to complete all items in sections: 1, 11, 111, IV, and IX. o
! ) 4 ZONING
(• AT (LOCATION) I (-- 7 ' l DISTRICI'�
LOCATION IN 0.) (STREEP
OF BETWEEN AND
BUILDING (CROSS STREET) (CROSS STREET)
LOT
SUBDIVISION LOT BLOCK SIZE
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, ❑
4 ❑ Repair, replacement t 21 ❑ Parking garage
or dormitory — Enter number
5 F-1 Wrecking (If multifamily residential, of units ... 22 ❑ Service station, repair garage
enter number of units in building in 15❑ Garage 23 ❑ Hospital, institutional
Part D, 13)
6 ❑ Moving (relocation) 16 ❑ Carport 24❑ Office, bank, professional
]L.
7 ❑ Foundation only
17❑ Other — Specify 25 ❑ Public utility
26 ❑ School, library, other educational
B. OWNERSHIP %!�'''_ '`j� { �- - ��' � 27 ❑ Stores, mercantile
f ❑
8°� Private (individual, corporation, v1 i'6 Tanks, towers
� �`
nonprofit institution, etc.) t�. ' �- 28 29 ❑ Other — Specify
9 ❑ Public (Federal, State, or a f
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�ublic 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 .....................
33 ❑ Reinforced concrete H. TYPE OF WATER SUPPLY
34 ❑ Other — Specify 42 ,r 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 F-1 Gas Will there a central air 52. Outdoors........................
36�biI conditioning.
L. RESIDENTIAL BUILDINGS ONLY
37❑ Electricity 44 ❑ Yes L_� No 53. Number of bedrooms..............
38 ❑ Coal
39 ❑ Other — Specify Will there be elevator?
Full.........
54. Number of
46 ❑ Y s 47 No bathrooms Partial........
hereby certify that the proposed work is authorized by the ow 'er of record ,
and I have been authorized by the owner to make this applic tion as his
authorized agent.
c
SIGNATURE OF AG1=NT'
ADDRESS
(NUMBER) (STREET) (CITY)
i
APPROVED BY TITLE
DATE 19
DEPT. FILE COPY
,nEPAR IENT OF BU=ING INSPECTIONS o 0 / r�,7 c
2 � STREET BUILDING 2" e47
._NORTON, rya.. 01060 PERMIT �r,
VALIDATION
31B - 35 Cade #79
DATE October 5. 19_79 PERMIT NO. 510
APPLICANT Charles T=er ADDRESS 16 Kyrtl.e
(NO.) (STREET) (CONTR'S LICENSE)
PERMIT TO Chi R A f nyA NUMBER OF
C �T (2_) STORY For WOQd�hl�rnin��--B-OV-e DWELLING UNITS 1
(TYPE OF LIMPROVEMENT) N0. (PROPOSED US€1
AT (LOCATION) 16 MVrtle ZONING
DISTRICT �C
(N0.) STREET)
rn BETWEEN AND
a (CROSS STREET) (CROSS STREET)
mSUBDIVISION LOT
LOT BLOCK SIZE
U
O 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
I
Ir (TYPE)
LL REMARKS: C.nns •'I' 3 _t metal bestos chinmey & install wood—burning stove
AREA OR
VOLUME ESTIMATED COST $ 750.00 FEE MIT $ 10.00
(CUBIC/SQUARE FEET)
OWNER Charl eiR Mirner
B EPT.
ADDRESS )hrtlP
(Affidavit on reverse side of application to be completed by authorized agent of owner)