17C-107 (14) VIII. ZONING PLAN EXAMINERS NOTES
DISTRICT /
USE
FRONT YARD
SIDE YARD SIDE YARD
REAR YARD
NOTES
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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.
J /T,
Owner or /
Lessee
Lj l�uvsti 1L ( Builder's
2, v t, 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 t7pplicant 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
Approval Number B I Check Date umer Permit Approval Check N
Date
Permit or A umber B
pP Obtained y P it or A 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
Building ,9 ll Use Group
Permit issued �121L 19 R`/�
Building Fire Grading
Permit Fee . /(if.� Live Landing
Occupancy Load
Certificate of Occupancy
Approved by:
Drain Tile
'r
Plan Review Fee
_IJTLE
NOTES and Data — (For department use)
ZT
/ f
Lam:
CITY OF NORTHAMPTON
OFFICE OF THE INSPECTOR OF BUILDINGS
212 MAIN STREET APPLICATION FOR
NORTHAMPTON, MA. 01060 PLAN EXAMINATION AND
BUILDING PERMIT
z
IMPORTANT — Applicant to complete all items in sections: 1, 11, 111, IV, and IX. O
ZONING
I• AT (LOCATION) /f j' Al DISTRICT
LOCATION (NO.) (STREET,)
OF BETWEEN AND
BUILDING (CROSS STREET) (CROSS STREET)
LOT
SUBDIVISION LOT BLOCK SIZE
N
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 12,0?rOne family 18 ❑ Amusement, recreational
of new housing units added, if any, 13 ❑ Two or more family — Enter 19 ❑ Church, other religious
i Part D, 13) number of units— — — — --�
3 All teration (See 2 above) 20 ❑ Industrial
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) % 24❑ Office, bank, professional
16 Carport
6 ❑ Moving (relocation) ❑ p
17 Other — Specify u 25 ❑ Public utility
7 ❑ Foundation only r
26 ❑ School, library, other educational
B. OWNERSHIP —'f� yZ"G 27 ❑ Stores, mercantile
e,�'J Private (individual, corporation, /� j�� 28 ❑ Tanks, towers
nonprofit institution, etc.) ����� t�t y 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
C .a 0(-, processing plant, machine shop, laundry building at hospital, elementary
10. Cost of improvement,,,,,,,,,,,,,,,, /..5 C' 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 $
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 v
30 Masonry (wall bearing) 40,A 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 Exterior"—/
32 ❑ Structural steel dimensions ...., __ 1'f
33❑ Reinforced concrete H. TY E OF WATER SUPPLY ✓ .
34❑ Other — Specify 42,.F Public or private company 50. Total land area, sq. ft. ...........
43 ❑ Private (well, cistern) K. NUMBER OF OFF-STREET
PARKING SPACES /
51. Enclosed ............1......... —
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
37I'll Electricity 44 ❑ Yes 45 VNo 53. Number of bedrooms..
38 ❑ Coal
39 ❑ Other — Specify Will there be an elevator? Full..
54. Number of
46 ❑ Yes 47 XNo bathrooms
Partial.......
hereby certify that the proposed work is authorized by the owner` of eecord
and I 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 19
DEPT. FILE COPY
DEPARTMENT OF BUILDING INSPECTIONS ZO
D-
212 MAIN STREET BUILDING
NORTHAMPTON, MA, 01060 PERMIT
rC VALIDATION
17C - 107 CODE # 79
DATE February 15o 1990 PERMIT NO. 88
APPLICANT �A..i @s ADDRESS 81 Hi oh
(N0.) ( BEET) (CONTR'S LICENSE)
NUMBER OF
PERMIT TO Al terations & atnve (_ 7 1 STORYkitehon rtan. - weed Stave DWELLING UNITS '
(TYPE OF IMPROVEMENT) NO. (PROPOSED USE)
AT (LOCATION) 81 - H i,Rh D STN CT UR$
(NO.) (STREET)
w BETWEEN AND
'o (CROSS STREET) (CROSS STREET)
w
LOT
IL
m SUBDIVISION 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 (TYPE)
K
REMARKS: Instal I mat-1- chJSZLay-�c `A00d-b1j=j' g sat'o3zo
Renovate kitche window replaced, insulate walls, sheetrock, kitchen cabinets
& counters. N `
AREA OR PERMIT
VOLUME ESTIMATED COST $ gj nn FEE $
(CUBIC/SQUARE FEET)
OWNER JamagM. Boles
Corized PT
ADDRESS 81 High Street, Northampton. Ma. 01060
(Affidavit on reverse side of application to be completed by auagent of owner)