17A-235 (3) VIII. ZONING PLAN EXAMINERS NOTES
DISTRICT
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 — Number, street, city, and State ZIP code Tel. No.
Owner or
Lessee
Builder's
2.
License No.
Contractor
f Nom/
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
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
rova I Check Date Number Approval Number B I Check Date
Permit or A umer
pp N be B Obtained y Permit or A pp Obtained y
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 T
Building �/' Use Group
Permit issued 19
Fire Grading
Building
Permit Fee $ Live Loading
Occupancy Load
Certificate of Occupancy $
A ed by: t
Drain Tile $
Plan Review Fee $
TITLE
NOTES and Data — (For department use) '
1
.r-
CITY OF NORTHAMPTON
OFFICE OF THE INSPECTOR OF BUILDINGS
212 MAIN STREET APPLICATION FOR
NORTHAMPTON, MA. 01060 -7� ! 2 PLAN EXAMINATION AND
BUILDING PERMIT
z
IMPORTANT — Applicant to complete all items in sections: I, 11, 111, IV, and IX. O
ZONING
AT (LOCATION)
DISTRICI
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(IJ residential, enter number 12 One family 18 F-1 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, 21 ❑ Parking garage
4 ❑ Repair, replacement or dormitory - Enter number
5 ❑ Wrecking (if multifamily residential, of units ------- - -i 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 - SpeciJy 25 ❑ Public utility
7 ❑ Foundation only
26 ❑ School, library, other educational
B. OWNERSHIP 27 ❑ Stores, mercantile
8 �Z Private (individual, corporation, 28 ❑ Tanks, towers
nonprofit institution, etc.) �3t 29 ❑ Other - Specify
9 ❑ Public (Federal, State, or ( �J'
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,,,,,,,,,,,,,,,, 150 — 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 /
30❑ Masonry (wall bearing) 40 Public or private company 48• Number of stories................
49• Total square feet of floor area,
31 Wood frame 41 Private (septic tank, etc.)
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
Wi ere be central air 52. Outdoors........................
con ti o ?
di
36 ❑ Oil L. RESIDENTIAL BUILDINGS ONLY
37A Electricity 44 ❑ Yes 45°.. f No
r ❑ 53. Number of bedrooms.............
38 ❑ Coal ,j` .
39 ❑ Other - Specify Will t e be an elevator? 54. Number of Full..........
❑ Yes 47 ❑ No bathrooms
Partial.......
hereby certify that the prop6tz4t work is authorized by the owner of record �►
and I have been authorized `by the owner to make #hid application as his_
authorized agent.
SIGNATURE OF AGENT
ADDRESS
(NUMBER) (STREET) (Cl TY)
APPROVED BY TITLE
DATE 19
r
P
DEPARTMT OF BUILDING INSPECTIONS Z o DEPT. FILE COPY
212 MAIN STREET TORN . 01060 BUILDING a
,JJ
17A - 235 Code #7 PER-MIT 9 VALIDATION
DATE December 5, ,g 7_ PERMIT NO. 695
APPLICANT Floyd Andrus ADDRESS 81 Lake
(NO.) (STREET) (CONTR'S LICENSE)
^� y, NUMBER OF
PERMIT TO__InAtF01 MOM AthOVe ( 1 STORY Whnd, bii Fn g 9'tOVA DWELLING UNITS
(TYPE OF IMPROVEMENT) NO. (PROPOSED USE)
p ZONING
AT (LOCATION) 81 lake DISTRICT URB
(NO.) (STREET)
a BETWEEN AND
(CROSS STREET) (CROSS STREET).
a
B. LOT
M SUBDIVISION LOT BLOCK SIZE
a
0 BUILDING IS TO BE FT. WIDE BY FT. LONG BY FT. IN HEIGHT AND SHALL CONFORM IN CONSTRUCTION
O
O
O
Z TO TYPE USE GROUP BASEMENT WALLS OR FOUNDATION
I
it (TYPE)
O
I, REMARKS:.
,0Ve ahjnMey (2 flues)
AREA OR $
VOLUME ESTIMATED COST $ 5Q.O0 FEEMIT 10.00
(CUBIC/SQUARE FEET)
OWNER Floyd Andrus
ADDRESS 81 TAkp R+rp-At,,, 71TOT_'"k�1_a =]"td)n.. Mar BaDI
(Affidavit on reverse side of application to be completed by authorized agent of owner)