05-044 (2) VIII. ZONING PLAN EXAMINERS 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 -�� 1t`: /Vt �CT1 N1� �' ° / r BLS 1 J
Lessee -
Builder's
2. License No.
Contractor
3.
Architect or
Engineer
I hereby Trtify tat the prapased work is authorized by the owner of record and that I have been authorized by the owner to
make this ppli ation as
PIP
uthorized agent and we agree to conform to all applicable laws of this jurisdiction.
Signature of pppli_ ant n' Address Appli/cat{ion date
t
00 NOT WRITE BELOW THIS LINE
V. PLAh REVIEW RECORD — For office use
Plans Review Required Check Plan Review Date Plans By Date Plans By Notes
Fee Started Approved
BUILDING
PLUMBING
MECHANICAL
ELECTRICAL
OTHER Is
VI. ADDITIONAL PERMITS REQUIRED OR OTHER JURISDICTION APPROVALS
Date Dote
Permit or Approval Check Obtained 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
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
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Plan Review Fee l
LE
NOTES and Data — (For department use)
CITY OF NORTHAMPTON
OFFICE OF THE INSPECTOR OF BUILDINGS 1
212 MAIN STREET APPLICATION FOR
NORTHAMPTON, MA. 01060 PLAN EXAMINATION AND
BUILDING PERMIT
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IMPORTANT — Applicant to complete all items in sections: 1, 11, 111, IV, and IX. o
�.,(�/ ZONING _
I• AT (LOCATION) v`( / 7, t(� (7 �p �t�,- DISTRICT
LOCATION (NO' (STREET) n
OF BETWEEN Zre' 7f 7l -t el ii ;(1// b!". AND,—,PLC --
BUILDING ' (CROSS STREET) (CROSS STREET)
LOT
SUBDIVISION LOT 2��BLOCK SIZE t�tJ
t� d"Y
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
L m
1 .New br: j'r Y U.> �'-
Residential Nonresidential
2 D Addition(I residential, enter number
� 12 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
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 ——————— — --o. 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) ❑ p r /Jd� J("(j y 25 Public utility
17 X Other — Specify' ❑
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
y 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 l�... [[/,! �y
11. TOTAL COST OF IMPROVEMENT $ 6, > 1
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 ❑ 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 44 ❑ Yes 45❑ No 53. Number of bedrooms..............
38 ❑ Coal
39 ❑ Other— Specify Will there be an elevator? 54. Number of Full..........
46 ❑ Yes 47 ❑ No bathrooms
Partial.......