17A-260 (3) VIII. ZONING PLAN EXAMINERS NOTES
DISTRICT
USE
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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
/7 r >'Ti r2 c.
Bui Ider'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.
Sign%ture of applicant Address Application date
LG Ft � C �f
00 NOT WRITE BELOW THIS LINE
V. PLAN 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 Date
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 Y
Building Use Group
Permit issued ' 19�
Building _ Fire Grading
Permit Fee $ ��/ J - - Live Loading
Certificate of Occupancy $ Occupancy Load
Approved by:
Drain Tile $
Plan Review Fee
r %
NOTES and Data — (For department use)
fd
y
CITY OF NORTHAMPTON
OFFICE OF THE INSPECTOR OF BUILDINGS
212 MAIN STREET APPLICATION FOR
NORTHAMPTON, MA. 01060 PLAN EXAMINATION AND
BUILDING PERMIT
z
IMPORTANT — Applicant to complete all items in sections: 1, 11, 111, IV, and IX. O
/ y ZONING
I. ` ( I � S/ DISTRICT
AT (LOCATION)
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 ❑ ew building Resid ntial Nonresidential
2 Addition(If residential, enter number 12 7One 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 ------- - -- 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 F-1 Moving (relocation)
17 Other - SpeciJy L±/-,JI'? /' 25 ❑ Public utility
7 ❑ Foundation only
26 ❑ School, library, other educational
B. OWNERSHIP L'C)/�) 27 ❑ Stores, mercantile
28 ❑ Tanks, towers
8 nonprofit(individual, corporation, 29 ❑ Other - Specify
non rofit institution, etc. P JY
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,,,,•••••••••.•• q school, secondary school, college, parochial school, parking garage for,
deportment 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 1$
III. SELECTED CHARACTERISTICS OF gUfLDING — 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 e�{tfrior -�
32 F-1 Structural steel dimensions . .l�i... ..�
33 ❑ Reinforced concrete H. TYPE OF WATER SUPPLY
34 F-1 Other - Specify 42 ❑ Public or private company 50. Total land area, sq. fT. ...........
43 r❑ Private (well, cistern) K. NUMBER OF OFF-STREET
PARKING SPACES
51. Enclosed ............
.s:•,-.......
F. PRINCIPAL TYPE OF HEATING FUEL I. TYPE OF MECHANICAL
35 ❑ Gas Will there be central air 52. Outdoors.............+......
36 ❑ Oil conditioning? ONLY
L. RESIDENTIAL BUILDINGS ONLY
37❑ Electricity 44 ❑ Yes 45 ON O 53. Number of bedrooms..............
38 ❑ Coal /
39 Other- Specify Will there be an elevator? Full..........
54. Number of
46 ❑ Yes 47 Z"Na 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 applkation as his
authorized agent.
SIGNATURE OF AGENT
ADDRESS w
(NUMBER) (STREET) (CITY)
APPROVED BY TITLE
DATE 19
DEPT. FILE COPY
zo
IJCP'T, OF BUILDING INSPECTRM BUILDING
212 Main Street PERMIT
VALIDATION
Northampton,Mass,01068 17A,26o
DATE Ontober 6. '1
p 19 78 PERMIT NO. 47
APPLICANT Anna Nutting ADDRESS 89 Oak Street, Florence
(NO.) (STREET) (CONTR'S LICENSE)
1 NUMBER OF
PERMIT TO Res-(TYPE qAddition T) o) STORY F8T1311� ROOTIISE) DWELLING UNITS
ZONING
AT (LOCATION) 89 oak - DISTRICT TTRR
INC.-) (STREET)
a BETWEEN AND
�o (CROSS STREET) (CROSS STREET)
T
LOT
a SUBDIVISION LOT BLOCK SIZE
m
a
p BUILDING IS TO BE �6 FT. WIDE BY �n FT. LONG BY FT. IN HEIGHT AND SHALL CONFORM IN CONSTRUCTION
m
z TO TYPE USE GROUP BASEMENT WALLS OR FOUNDATION
F (TYPE)
K
0
LL REMARKS:
AREA OR �O ESTIMATED COST $ 5,000 FEEMIT 15.00
VOLUME
(CUBIC/SQUARE FEET)
OWNER Tinnald & Anna bbitting BUIL ING
ADDRESS 89 Oak Streets, Floreice, Ma. BY
(Affidavit on reverse side of application to be completed by authorized agent of owner)