17C-144 (6) VIII. ZONING PLAN EXAMINERS NOTES
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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. oA!✓ d 8 O E' e.s 67 Fl o/"e J✓c � M . 0/p60 �8 3
Owner or
Lessee
Builder's
2. /y 111' License No. $6-4.5-9-
Contractor
o�z1a7/
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
00 NOT WRITE BELOW THIS LINE
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 Obtai ed 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
V11. VALIDATION
Building FOR DEPARTMENT USE ONLY
Permit number
Building Use Group
Permit issued 19
Building Fire Grading
Permit Fee $ Live Loading
Certificate of Occupancy $ Occupancy Load
Approved by:
Drain Tile
Plan Review Fee $
E
NOTES and Data — (For department use)
CITY OF NORTHAMPTON
OFFICE OF THE INSPECTOR OF BUILDINGS
212 MAIN STREET APPLICATION FOR
NORTHAMPTON, MA. 01060 PLAN EXAMINATION AND
7G / BUILDING PERMIT
z
IMPORTANT — Applicant to complete all items in sections: I, 11, 111, IV, and IX. O
(� p��` T ZONING )
I• AT (LOCATION) / O lP_ Sze-s 's DISTRICT
LOCATION (NO.) (STREET)
Sr ST
OF BETWEEN M,kiN 3�' �Ld i'P/✓ C'Q- _AND � (CROSS STREET)
BUILDING (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 M
m
1 ❑ New building Residential Nonresidential
2 ❑ Addition(If residential, enter number 12 X1 One family 18 ❑ Amusement, recreational
of new housing units added, if any, 13 F—] Two or more family — Enter 19 ❑ Church, other religious
in Part D, 13) number of units— — — — � 20❑ Industrial
3 Alteration (See 2 above) 14 Transient hotel, motel,
❑ Repair, replacement 21 ❑ Parking garage
4
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❑ 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................ !jam 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 a
30❑ Masonry (wall bearing) 40& Public or private company 48. Number of stories................
31 Wood frame 4 1 0 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 [30 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 Y No 53. Number of bedrooms.............. v
38 ❑ Coal
39❑ Other — Specify Will there be an elevator? 54. Number of Full..........
46 ❑ Yes 47 to No bathrooms
Partial.......
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ry
Z 0
lt2 W it, St not
Ig BUILDING
vox*"todo mus. 0100
PERMIT 044
17C 144 VALIDATION
DATE PERMIT NO. 217
APPLICANT Gary C, wordon ADDRESS. Street
(NO.) (STREET) (CONTA'S LICENSE)
NUMBER OF
PERMIT TO A441 tim ,,STORY DWELLING UNITS
(TYPE Of IMPROVEMENT) 707 (PROPOSED USE)
ZONING
AT (LOCATION) , 40 In&& Street DISTRICT "s
(NO.) (STREET)
BETWEEN (CROSS STREET) AND A- (CROSS STREET)
LOT
SUBDIVISION b LOT-BLOCK SIZE
FT. IN HEIGHT AND SHALL IN CONSTRUCTION
BUILDING IS TO BE FT. WIDE BY FT. LONG BY
TO TYPE USE GROUP BASEMENT WALLS OR FOUNDATION
(TYPE)
REMARKS. Dovai t to rem"*1 first mor bathroom and add a bath on the $00*04 fl**T
S.
50000000 PERMIT $ 20,00
AREA OR ESTIMATED COST FEE
VOLUME
(CUBIC/SQUARE FEET)
0 T
OWNER jobs A lkw&ara mattalkaft BUILDI 4G -1.
ADDRESS 40 BY -moi"of it oodzlm
WHITE - FILE COPY GREEN FIELD' COPY CANARY APPLICANT COPY PINK (-;�—SiSSORS COPY
Department of Buildir- In ections DING C�
212 rain Street BUILDING^� .. �° � D
Northampton, Mass. 01060 PERMIT a Ia ,
I"
17C - 144 VALIDATION
DATE May 11. 1 PERMIT NO. 217
APPLICANT ADDRESS
Gary C. Worden �9"t es nu Street 014271
(NO.) (STREET) (CONT R'S LICENSE)
Addition NUMBER OF
PERMIT TO (_) STORY DWELLING UNITS
(TYPE OF IMPROVEMENT) NO. (PROPOSED USE)
ZONING
AT (LOCATION) 40 KeveS Street DISTRICT
(N0.) (STREET)
BETWEEN AND
(CROSS STREET) (CROSS STREET)
LOT
SUBDIVISION LOT BLOCK SIZE
BUILDING IS TO BE FT. WIDE BY FT. LONG BY FT. IN HEIGHT AND SHALL CONFORM IN CONSTRUCTION
TO TYPE USE GROUP BASEMENT WALLS OR FOUNDATION
(TYPE)
REMARKS: ermlt to remodel first floor bathroolTi and add a bath on the second floor
AREA OR 5,000.00 PERMIT $ 20.00
VOLUME ESTIMATED COST $ FEE
(CUBIC/SQUARE FEET)
OWNER John & Barbara Matteson
BUILDI G D PT.
ADDRESS 40 Keyes Street BY
WHITE - FILE COPY . GREEN - FIELD COPY • CANARY - APPLICANT COPY PINK - SSESSORS COPY