12C-070 (11) 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.
Owner or t� t
Lessee
7
Builder's
2. i 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 pp)icant 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
Permit or A roval Check Date Number By Permit or Approval Check Date Number By
PP Obtained Obtained
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 �1 ,// Use Group
Permit issued (} e T19
Building
/ J Fire Grading
�
k s
Permit Fee Live Loading
Occupancy Load
f-ertificote of Occupancy
A ved by:
Drain Tile
plan Review Fee
TITLE
AMW
NOTES and Data — (For department use)
I
i
h
w 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
,� ZONING
(• AT (LOCATION) /_ :;k4
e DISTRIC
LOCATION NO.) (STREET),
OF BETWEEN AND_
BUILDING (CROSS STREET) (CROSS STREET)
LOT
SUBDIVISION LOT BLOCK SIZE
V1
II. TYPE AND COST OF BUILDING — All applicants complete Parts A — D --�
A. TYPE OF IMPROVEMENT D. PROPOSED USE - For"Wrecking" most recent use Im
M
1 aAddition ew build ing Reside tial Nonresidential
2 (If residential, enter number 12ZOne 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
3F-] Alteration (See 2 above) 14 ❑ Transient hotel, motel,
21 ❑ Parking garage
4 ❑ Repair, replacement or dormitory - Enter number
5 ❑ 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)
16 ❑ Carport 24❑ Office, bank, professional
6 ❑ Moving (relocation)
❑ 17�ther - Specify�'z�- 25 ❑ Public utility
7 Foundation only 26 ❑ School, library, other educational
B. OWNERSHIP 27 ❑ Stores, mercantile
8'5�d7lPrivate (individual, corporation, 28 ❑ Tanks, towers
nonprofit institution, etc.) �Z � 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
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 $r . /)e
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 feet of floor area
all floors, based on exterior
32 ❑ Structural steel dimensions ...................
33 ❑ Reinforced concrete H. TYPE/f1F WATER SUPPLY
34F--] 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. PRIN PAL TYPE OF HEATING FUEL I. TYPE OF MECHANIC 51. Enclosed .......................
351 Gas Will there central 'r Se:. 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 n elev tor? Full.......... V
5t1. Number of
46 ❑ Yes 4 ❑ No bathrooms Partial..
I hereby certify that the proposed work is authorized by the owner of record
and 1 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 1g
r
DEPT. PILE COPY
DEPARTMELQT OF BUILDI[�TTG INSPECTIONS :3-
212 MAIN STREET BUILDING Qa
NORTHAMPTON, MA. 01060 PERMIT
VALIDATION
12C - 70 Code #79
DATE October 29, 19 7— PERMIT NO. 625
APPLICANT A. Cate ADDRESS 42 Ca-vol -
(NO.) (STREET) (CONTR'S LICENSE)
NUMBER OF
PERMIT TO Chlmn.ey & Stove STORY Fnr urnnrl—burni o .
ng 4 . V DWELLING UNITS
(TYPE OF IMPROVEMENT) NO. (PROPOSED USE)
ZONING
AT (LOCATION) 42 DISTRICT jJQ
(N0.) (STREET)
a BETWEEN AND
m (CROSS STREET) (CROSS STREET)
0
LOT
D. SUBDIVISION LOT BLOCK- SIZE
m
U BUILDING IS TO BE FT. WIDE BY FT. LONG BY .FT. IN HEIGHT AND SHALL CONFORM IN CONSTRUCTION
O
M
Z TO TYPE USE GROUP BASEMENT WALLS OR FOUNDATION
(TYPE)
E
LL REMARKS: ono root exterior masonry �hh imney & wood burning stove instal l afion
AiC
AREA OR ESTIMATED COST $ 200 00 FEEMIT .� 10.00
VOLUME
(CUBIC/SQUARE FEET)
OWNER Addison Cate BUI I T
ADDRESS 4P Carol. St-. NI ton y Ma 01060 BY
(Affidavit on reverse side of application to be completed by authorized agent of owner)