17A-133 (4) VIII. ZONING PLAN EXAMINERS NOTES
DISTRICT
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USE
FRONT YARD
SIDE YARD SIDE YARD
REAR YARD
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 — Numbcr, street, city, and State ZIP code Tel. No.
Owner or
Lessee
Builder's
2.
License No.
Contractor 9
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.
Signatu p lie nt Address Apphcatio date
00 NOT WRITE BELOW THIS LINE
V. PLAN REVIEW RECORD — For office use
Plan Review Date Plans Date Plans
Plans Review Required Check Fee Started BY Approved BY Notes
BUILDING
PLUMBING
MECHANICAL
ELECTRICAL
OTHER
VI. ADDITIONAL PERMITS REQUIRED OR OTHER JURISDICTION APPROVALS
rovaI Check Date Number B Permit or Approval Check Date Number By
Permit or A
PP Obtained y PP Obtained
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 Use Group
Permit issued di 19 R�oZL
Building // Fire Grading
Permit Fee $ �D DQ Live Loading
Occupancy Load
Certificate of Occupancy
Approved by:
Drain Tile
Plan Review Fee
t
NOTES and Data — (For department use)
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4
APPLICATION FOR
PLAN EXAMINATION AND
BUILDING PERMIT
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IMPORTANT — Applicant to complete all items in sections: 1, 11, 111, IV, and IX. O
I
I• AT (LOCATION) ZONING // n
DISTRICT
LOCATION (NO.) (STREETV
OF BETWEEN AND
BUILDING (CROSS STREET) (CROSS STREET)
LOT
SUBDIVISION LOT BLOCK SIZE
to
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
rn
1 ❑ N building Re ential Nonresidential
2 Addition(If residential, enter number 12 ne family 18 ❑ Amusement, recreational
f new housing units added, if any,
in Part D, 13) 13❑ Two or more family — Enter 19 ❑ Church, other religious
Alteration (See 2 above) number of units— — — — --)P. 20 ❑ Industrial
14 ❑ Transient hotel, motel, 21 ❑ Parking garage
4 ❑ Repair, replacement or dormitory — Enter number
5 El 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)
7 ❑ Foundation only 17❑ Other — Specify 25 ❑ Public utility
26 ❑ School, library, other educational
B. OWNERSHIP 27 ❑ Stores, mercantile
88X 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 $
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 W.
E. PRINCIPAL TYPE OF FRAME G. TYPE OF SEWAGE DISPOSAL J. DIMENSIONS
30[_j Masonry (wall bearing) 40) Public or private company 48• Number of stories...............
31X Wood frame 41 ❑ Private (septic tank, etc.) 49. Total square feet of floor area,
all floors, basecj, ri r--n'32 ❑ Structural steel dimensions .. /.. >�. ...
33 ❑ Reinforced concrete H. TYPE OF WATER SUPPLY
34 ❑ Other — Specify 42 Public or private company 50. Total land are 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 ❑ No 53. Number of bedrooms..............
38 ❑ Coal
39❑ Other — Specify Will there be an elevator? Full..........
54. Number of
46 ❑ Yes 47 ❑ No bathrooms
Partial.......
Department of Building Inspecttons z
212 Main Str,*et BUILDING
a
Northalo to' n, Ma. 1060 PERMIT a
17A - 133 VALIDATION
DATE July 12, 1g 82 PERMIT NO. 321
APPLICANT Curtis Swenson ADDRESS 26 Glendale St., Easthamnton
(NO.) (STREET) (CONTR'S LICENSE)
PERMIT TO Addition NUMBER OF
(�) STORY open QTj�G�I DWELLING UNITS 1
(TYPE OF IMPROVEMENT) N0. (PRFPOSED USE)
ZONING
AT (LOCATION) 373 Bridge Road DISTRICT M
(NO.) (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: Open_porcb 14' X 15'
AREA OR
VOLUME ESTIMATED COST ` rj0,0■00 FEEMIT $ 10-00
(CUBIC/SQUARE FEET)
OWNER ArdpII r-_4mer
BUIL G PT.
ADDRESS 323 Brie Road, Northampton, Na, 01061) BY
WHITE - FILE COPY . GREEN - FIELD COPY CANARY - APPLICANT COPY PINK - ASSESSORS COPY