17A-060 (3) 1�12 G ;
VIII. ZONING PLAN EXAMINERS NOTES
DISTRICT x
USE
FRONT YARD
SIDE YARD SIDE YARD
REAR YARD
NOTES
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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.
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
)Ze
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
q Fee Started y Approved y
BUILDING
PLUMBING
MECHANICAL
ELECTRICAL
OTHER
VI. ADDITIONAL PERMITS REQUIRED OR OTHER JURISDICTION APPROVALS
Date D
Permit or Approval Check Obtained Number By Permit or Approval Check Obttaitned 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 Cc'
Building
Permit issued 19�
Building Fire Grading
Permit Fee $ /�•��� Live Loading
Certificate of Occupancy $ Occupancy Load
Approved by:
Drain Tile
Plan Review Fee r �
TIT
NOTES and Data — (For department use)
y
F _ ,
CITY OF NORTHAMPTON
' OFFICE OF THE INSPECTOR OF BUILDINGS
212 MAIN STREET APPLICATION FOR
NORTHAMPTON, MA. 01060 PLAN EXAMINATION AND
1,,7 1-4 ,Z® BUILDING PERMIT
z
IMPORTANT — Applicant to complete all items in sections: 1, 11, 111, IV, and IX. O
I• AT (LOCATION) ZONING
c ��"7'�� � �1 DISTRICT 4��
LOCATION (N0.) (STREET)
OF BETWEEN AND
BUILDING (CROSS STREET) (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 Re idential Nonresidential
2 Addition(I residential, enter number
❑ I 1 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
3'M Alteration (See 2 above) number of units— — — — --)� 20 ❑ Industrial
14 ❑ Transient hotel, motel, 21 ❑ Parking garage
4 ❑ Repair, replacement or dormitory — Enter number 22 Service station, repair garage
5 ❑ Wrecking (If multifamily residential, of units ------- —
enter number of units in building in 15 ❑ Garage 23 ❑ Hospital, institutional
Part D, 13) ❑
16 Carport 24❑ Office, bank, professional
6 ❑ Moving (relocation)
F__] 17� Other — Specify 25 ❑ Public utility
7 Foundation only r
� 26 ❑ School, library, other educational
B. OWNERSHIP � -- 27 ❑ Stores, mercantile
28 ❑ Tanks, towers
8 Private (individual, corporation, Specify
Other — S
nonprofit institution, etc.) 29 ❑ p fy
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
III. SELECTED CHARACTERISTICS OF 9UILDING — 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 f�
30❑ Masonry (wall bearing) 40 Public or private company Number of stories.......r!` ..
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 .......................
35❑ Gas Will there be central air 52. Outdoors........................
36 Oil conditioning?
L. RESIDENTIAL BUILDINGS ONLY
37 Electricity 4❑ Yes 45A No
y 53. Number of bedrooms..............
38 ❑ Coal
39❑ Other — Specify Will there be an elevator? 54. Number of Full..........
46 ❑ Yes 47 o bathrooms
Partial.......
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hereby certify that the proposed work is authorized by the owner of record
and I have been authorized by the owner to make this application as his
authorized agent. -
SIGNATURE Or 'AGENT' '
ADDRESS -
(NUMBER) (STREET) (CITY)
3
APPROVED BY TITLE
DATE 19
DEPT. FILE COPY
DEPARTI,WT 01, BUILDING INSPECTIONS z O
D-
.212 MAIN STREET NORTF�TONMA. o 1 060 BPU 1 LRDM�1 IVG Q a
17A - 6 0 Code #79
DATE October ]50. 19 7!� PERMIT NO. 626
APPLICANT Edward T, dlesk; ADDRESS .905 No M T)12 St_ 0 F-I O-
(NO.) (STREET) (CONTR'S LICENSE)
_ NUMBER OF
PERMIT TO_ Wn(TYPE OPOIMPROYEMENT) (•NO) STORY Wood-bit RoPOS�EIrus�e DWELLING UNITS �
ZONING
AT (LOCATION) 205 NO N=le DISTRICT URB
(NO.) (STREET)
a BETWEEN AND
b
(CROSS STREET) (CROSS STREET)
01
LOT
a SUBDIVISION LOT BLOCK SIZE
m
Q
O
BUILDING IS TO BE FT. WIDE BY FT. LONG BY FT. IN HEIGHT AND SHALL CONFORM IN CONSTRUCTION
m
O
Z TO GROUP BASEMENT WALLS OR FOUNDATION
� (TYPE)
0:
REMARKS: Install wood—burning stove in.-existing chimney
AREA OR PERMIT
VOLUME ESTIMATED COST $ 4OO OO FEE $ 10.00
(CUBIC/SQUARE FEET)
OWNER Edward T. GDcleski
�� BUIL ING PT.
ADDRESS _ 205 NO M=le St., Flnr n , r Ma. 01060 ev
(Affidavit on reverse side of application to be completed by authorized agent of owner)