03-034 VIII. ZONING PLAN EXAMINERS NOTES
DISTRICT
USE
FRONT YARD
SIDE YARD SIDE YARD
REAR YARD
NOTES —I
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BOCA FORM APEBP - 669 C1969 BUILDING OFFICIALS & CODE ADMINISTRATORS INTERNATIONAL, INC. .L`
IV. IDENTIFICATION — To be completed by all applicants
Name Mailing address — Number, strut, city, and State ZIP code Tel. No.
Owner or c, - 1 '- (i
Lessee
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 applicant J" Addr s Application date
i
00 NOT WRITE BELOW THIS L IiE
V. PLAN REVIEW RECORD — For office use
Plans Review Required Check Plan Review Date Plans B Date Plans B Notes
9 Fee Started y Approved y
BUILDING $
PLUMBING $
MECHANICAL $
ELECTRICAL $
OTHER $
VI. 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 3
Building /% Use Group
Permit issued ac 19 _
Building T / Fire Grading
Permit Fee $ rd_ DD Live Loading
Certificate of Occupancy $ Occupancy Load
Approved by:
Drain Tile $
Plan Review Fee
ITLE
r
NOTES and Data — (For department use)
j� �
N
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) �'r% —°+` DISTRICT
LOCATION (NO.) (STREET)
OF BETWEEN AND
BUILDING (CROSS STREET) (CROSS STREET)
LOT
SUBDIVISION LOT BLOCK SIZE
Vr
II. TYPE AND COST OF BUILDING — A11 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 12X 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 or dormitory — Enter number 21 ❑ Parking garage
5M Wrecking (If multifamily residential, of units ——————— — --�o 22 ❑ Service station, repair garage
enter number of units in building in 15,N Garage 23 ❑ Hospital, institutional
Part D, 13)
6 ❑ Moving (relocation) 16 ❑ Carport .� 24❑ Office, bank, professional
17 V1 Other — Specify 25 ❑ Public utility
7 ❑ Foundation only / 26 ❑ School, library, other educational
B. OWNERSHIP 27 ❑ Stores, mercantile
8 Private (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.)............
11. TOTAL COST OF IMPROVEMENT I$
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 �n
30❑ Masonry (wall bearing) 40 ❑ Public or private company 48. Number of stories...........ir��
31 Wood frame 41M Private (septic tank, etc.) 49• Total square feet of floor area,
T .1 all floors, based on exterior
3 2❑ Structural steel dimensions .....................
33❑ Reinforced concrete H. TYPE OF WATER SUPPLY
34❑ Other — Specijy 42F-1 Public or private company
50. Total land area, sq. ft. ...........
43 K 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 XNa 53. Number of bedrooms..............
38�Coal
39 Other — SpeciJy i. Will there be an elevator? Full..........
54. Number of
46 ❑ Yes 47 No bathrooms
Partial.......
hereby certify that the proposed work is q+?ri4ed by. the Downer of record`
and I have been authorized by the owner to make this application as his
authorized agent.
SIGNATURE OF �AGiNT
ADDRESS -„ ,,, _-_. � a' �.��•_ u°� ...,;-'� .�. `.,
(NUMBER) (STREET) IciTY)
APPROVED BY TITLE
DATE 19 .
e .
DEPT. FILE COPY
DEPARTMENT OF BUILDING INSPECTIONS ��/ ZO
NOR CHAMPION MA.. 01060 22 j BUILDING Q a
J� PERMIT
VALIDATION
�-- DATE July 262 197_ PERMIT NO. 342
APPLICANT Marion D_Ta i ensue ADDRESS 7 inseed Rd F 14, Hatfield. Ma
(NO.) (STREET) (CONTR'S LICENSE)
NUMBER OF
PERMIT TO T11ami1it! &-reL19�r (2 STORY BB=19 & sheds DWELLING UNITS 1
(TYPE OF IMPROVEMENT) NO. (PROPOSED USE)
ZONING
AT (LOCATION) 604 Cpl as 9da Rona DISTRICT RR
(NO.) (STREET)
m BETWEEN AND
(CROSS STREET) (CROSS STREET)
rn
LOT
B SUBDIVISION LOT BLOCK SIZE
m
a
v 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)
f
Ir
OL REMARKS: Demolition Of eow barn-hay barn- tool sheds hay barns lean too
Unable to determine value
Repair eellaar to existing house
AREA OR PERMIT s 10,00
VOLUME ESTIMATED COST
Q1. (CUBIC/SQUARE FEET)
s e
OWNER rhen S & Marion Lapienski B LDI D PT.
ADDRESS j-imseed RoPA, West Hatfield.- Ma B
(Affidavit on reverse side of application to be completed by authorized agent of owner)