17B-027 (3) 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.
I. �1/2 ` cl ✓c l�" C
23U
Owner or
Lessee
l
Builder'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.
Signature of appl' Rt Address Application date
/ 00 NOT WRITE BEL04 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 Approval 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 Z 7�S
Building Use Group
Permit issued l 19
Fire Grading
Building
Permit Fee $ !y. 0C� Live Loading
Certificate of Y Ap d by:
Occupancy Occupancy Load
P �—
Drain Tile —
Plan Review Fee
TITLE
NOTES and Data — (For department use)
4t/cio-c/ 6U12nk.!!I� 37�2 v tea-
1E
CITY OF NORTHAMPTON
OFFICE OF THE INSPECTOR OF BUILDINGS
212 MAIN STREET APPLICATION FOR
NORTHAMPTON, MA. 01060 /71— c:217 PLAN EXAMINATION AND
BUILDING PERMIT
z
IMPORTANT — Applicant to complete all items in sections: 1, 11, 111, IV, and IX. 0
J ;; �` _ ZONING TC<2l
I. AT (LOCATION) id DISTRICT
LOCATION (NO.) (ST EET)
OF BETWEEN (CROSS STREET) AND (CROSS STREET)
BUILDING
LOT
SUBDIVISION LOT BLOCK SIZE
V1
II. TYPE AND COST OF BUILDING — All applicants complete Parts A — D
M
A. TYPE OF IMPROVEMENT D. PROPOSED USE — For"Wrecking" most recent use M
1 ❑ New building Residential Nonresidential
2 ❑ Addition(If residential, enter number 12 X One family 18 ❑ Amusement, recreational
of new housing units added, if any, 13'❑ Two or more family — Enter 19 ❑ Church, other religious
in Part D, 13)
number of units— — — — -i 20 ❑ Industrial
3 ❑ Alteration (See 2 above) 14 ❑ Transient hotel, motel,
21 ❑ Parking garage
4 ❑ Repair, replacement 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) 16 ❑ Carport 24❑ Office, bank, professional
6 ❑ Moving (relocation) 25 ❑ Public utility
17 [::] Other — Specify
7 ❑ Foundation only j� 26 ❑ School, library, other educational
B. OWNERSHIP �V.:17,Or 71,j,V 0 27 ❑ Stores, mercantile
28 ❑ Tanks, towers
8 Private (individual, corporation, ?/� ❑
nonprofit institution, etc.)
/'"� "��9 Other — SpeciJy
9 ❑ Public (Federal, State, or
local government)
C. COST (Omit cents) Nonresidential — Describe in detail proposed use of buildings, e.g., food
f( /-'� processing plant, machine shop, laundry building at hospital, elementary
10. Cost of improvement................ 'Y �j 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 $ L,
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
48. Number of stories................
30❑Masonry(wall bearing) 40 Public or private company
49. Total square feet of floor area,
31 Wood frame 41 ❑ Private (septic tank, etc.) all floors, based on exterior
32❑ Structural steel dimensions .....................
33 ❑ Reinforced concrete H. TYPE OF WATER SUPPLY
34❑ Other — Speci/y
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 — SpeciJy 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 thePowner of record
and I have been authorized 'by the owner to make this application as his
authorized agent.
r
SIGNATURE OF' AGENT
ADDRESS
(NUMBER) (STREET) (CITY)
APPROVED BY TITLE
DATE 19
DEPT. FILE COPY
212' BUILDING INSPECTIONS BU 1 t D 1�VG O<
NORTHAMPTON, MA. 01060 PERMIT
VALIDATION
17B — 27
DATE August 13, 19. 79 PERMIT NO. 375
APPLICANT__ Douglas Smith ADDRESS BOX 233, Fi'lorence; Ma„
(NO.) (STREET) (CONTR'S LICENSE)
NUMBER OF
PERMIT TO Construct ehimne —(-2—) STORY_Fbr uood burning stove DWELLING UNITS 1
(TYPE OF IMPROVEMENT NO. (PROPOSED USE)
ZONING
AT (LOCATION) 395 Bridge Road DISTRICT FIRM
(NO.) (STREET)
o,. BETWEEN AND
a
(CROSS STREET) (CROSS STREET)
a LOT
m SUBDIVISION LOT BLOCK SIZE
a
U
O BUILDING IS TO BE FT. WIDE BY FT. LONG BY FT. IN HEIGHT AND SHALL CONFORM IN CONSTRUCTION
ED
O
Z TO TYPE USE GROUP BASEMENT WALLS OR FOUNDATION
f
� (TYPE)
u- REMARKS: _- Construct exterior masonry NY& ebimney for wood burning stove
AREA OR
//"!„7../'7 s ,Ua pKJ L. F.r r^ .." S✓J<r;:.. f .,a,. rd.� .
VOLUME ESTIMATED COST $ �'50.00 FEEMIT $ 10.00
(CUBIC/SQUARE FEET)
OWNER . Douglas Smith
BU
ADDRESS Box 2330 Florence, Ma. 01060 BY /
(Affidavit on reverse side of application to be completed by authorized agent of owner)