05-038 (4) IV. K)ENTlFICATION — 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 his authorized agent and we agree to conform to all applicable laws of this jurisdiction.
e oftapplicant Address /ligation date
D0 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 is
VI. ADDITIONAL PERMITS REQUIRED OR OTHER JURISDICTION APPROVALS
Permit or Approva I Check Obta tned 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
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 $ `" '�
VIII. ZONING PLAN EXAMINERS NOTES jKeAjAJe6f1,
DISTRICT
USE N rA r^dv
FRONT YARD
SIDE YARD SIDE YARD
REAR YARD
NOTES yin G viC-n
IX. SITE OR PLOT PLAN - For Applicant Use
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BOCA FORM APEBP — 669 C1969 BUILDING OFFICIALS & CODE ADMINISTRATORS INTERNATIONAL, INC.
NOTES and Data — (For department use)
..f p�o
v
CITY OF NORTHAMPTON
OFFICE OF THE INSPECTOR OF BUILDINGS
212 MAIN STREET APPLICATION FOR
NORTHAMPTON, MA. 01060 PLAN EXAMINATION AND
rnA.Q C, r 3a BUILDING PERMIT
z
IMPORTANT — Applicant to complete all items in sections: 1, 11, 111, IV, and IX. O
�5/ �/ ue�� n / ZONING
I• AT (LOCATION) �\ /l / 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 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 Alteration (See 2 above)
number of units— — — — 20 ❑ Industrial
�
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)
7 ❑ Foundation only 17 ❑x Other — Specify LJC)0 ��OUt, 25 ❑ Public utility
26 ❑ School, library, other educational
B. OWNERSHIP 27 ❑ Stores, mercantile
8 F_V1 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,,,,,,,,,,,,,,,, U 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................
31 F5_61 Wood frame 41 Private (septic tank, etc.) 49. Total square feet of floor area,
It— all floors, based on exterior
32 ❑ Structural steel dimensions .....................
33 ❑ Reinforced concrete H. TYPE OF WATER SUPPLY
34 ❑ Other — Specify 42 F-] Public or private company 50. Total land area, sq. fT. ...........
43 yC 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 44 ❑ Yes 45 [R] 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.......
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'OF AGENT .
ADDRESS -
(NUMBER) (STREET) (CITY)
APPROVED BY TITLE
DATE 19
DEPARTMENT i ' BUILDING INSPECTIONS F PT. FILE COPY
212 MAIN STREET o° ��/�/
NOR1%4wmN, MA. 01 O6O BUILD 1 N G a ILC
5 — 38 Code #79 PERMIT VALIDATION
DATE November 2, 19 7..9 _ PERMIT NO. 634
APPLICANT Erik Geryais ADDRESS 591 Kennedy Rd., IAeds
(NO.) (STREET) (CONTR'S LICENSE)
NUMBER OF
PERMIT TO Alteratim ( 2 STORY Wbodr+bL1Plina stove DWELLING UNITS 1
(TYPE OF IMPROVEMENT) NO. (PROPOSED USE)
ZONING
AT (LOCATION) KEa R!@ Rd• D STRICT U
(N0.) (STREET)
a BETWEEN AND
b (CROSS STREET) (CROSS STREET)
a
LOT
a SUBDIVISION LOT BLOCK SIZE
m
O U 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
f (TYPE)
vO REMARKS: Install Woof-burniniz stove
AREA OR
VOLUME ESTIMATED COST $ 50-00 FEEMIT $ 10_00
(CUBIC/SQUARE FEET)
OWNER Erik B. GeryaI8 "
B D
ADDRESS 591 Kannedy Road_ LEEds, MS. B
(Affidavit on reverse side of application to be completed by authorized agent of owner)