17C-071 (6) VIII. ZONING PLAN EXAMINERS NOTES 1/�
DISTRICT ✓26
USE
FRONT YARD I
SIDE YARD JZ-4 SIDE YARD
REAR YARD
NOTES
IX. SITE OR PLOT PLAN — For Applicant Use
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BOCA FORM APEBP — 669 01969 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.
O s p pfa6d S y3� 0
Owner or
Lessee
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 applicant Address Application date
L�
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 Approval Check Date Number B Permit or Approval Check Date Number B
PP Obtained y pp Obtained 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 b
Building Use Group
Permit issued 19
Building
Fire Grading
//� �, /
Permit Fee $ G `VL'' Live Loading
Occupancy Load
Certificate of Occupancy
A ved by:
Drain Tile $
Plan Review Fee $
TITLE
NOTES and Data — (For department use)
a
w
CITY OF NORTHAMPTON
OFFICE OF TH15 INSPECTOR OF BUILDINGS
212 MAIN STREET APPLICATION FOR
NORTHAMPTON, MA. 01060 / 7 / PLAN UILD MIINATIONTANO
6 z
IMPORTANT - Applicant to complete all items in sections: 1, 11, III, IV, and IX. O
I. /� l /� J / ZONING
AT (LOCATION) � 'G— DISTRIC
LOCATION (NO.) (STREET)
OF BETWEEN_L(.A'-2Ir 3,17 AND
BUILDING (CROSS STREET) (CROSS STREET)
LOT
SUBDIVISION LOT BLOCK SIZE
H
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
-a
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 or dormitory — Enter number 21 ❑ Perking garage
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❑ 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 of hospital, elementary
10. Cost of improvement................ d8 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 $ 3 0 O
III. SELECTED CHARACTERISTICS OF B ILDING - 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 OF WATER SUPPLY
34 ❑ 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 .......................
35X 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.......
hereby certify that the proppssed work is authorized by the owner of record
and I have been authorized by the owner to make this d�pl-ication a§ his '
authorized agent.
SIGNATURE Or *AGENT
ADDRESS
(NUMBER) (STREET) (CITY)
APPROVED BY TITLE
DATE 19
DEPARTMENT OF BUILDING INSPECTIONS Z o DEPT. FILE COPY
212 MAIN A. 01064 BUILDING �a
17C -' 71 CODE #79 PERMIT VALIDATION
DATE April 789 19X80 PERMIT NO. 209
APPLICANT ADDRESS 91 Cheatn,t>It Sty' Florence
(NO.) (STREET) (CONTR'S LICENSE)
NUMBER OF
PERMIT TO Al tarntfon (_2_) STORY Family Room DWELLING UNITS
(TYPE OF IMPROVEMENT) NO. OPROPOSED USE)
ZONING URB
AT (LOCATION) DISTRICT
(N0.) (STREET)
a BETWEEN MAin AND Bridge Rd.
�o (CROSS STREET) (CROSS STREET)
a
LOT
IL SUBDIVISION LOT BLOCK SIZE
m
a
U BUILDING IS TO BE FT. WIDE BY FT. LONG BY FT. IN HEIGHT AND SHALL CONFORM IN CONSTRUCTION
0
0
Z TO TYPE USE GROUP BASEMENT WALLS OR FOUNDATION
� (TYPE) _
0:
O
LL REMARKS:
AREA OR PERMIT Q 1 0,Q0
VOLUME ESTIMATED COST P
(CUBIC/SQUARE FEET)
OWNER Gary Warden
ADDRESS Q1 Cheatwit�Stree t Florpnca} XA- 01060
(Affidavit on reverse side of application to be completed by authorized agent of owner)