17C-159 (5) 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 01969 BUILDING OFFICIALS & CODE ADMINISTRATORS INTERNATIONAL, INC.
IV. IDENTIFICATION — To be completed by all applicants
Name��,���q�� Mailing address — Number, street, city, and State ZIP code Tel. No.
Owner or
Lessee
Builder's
2. License No.
Contractor
3. w�
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
�.. . /0- e 7—7 9
= 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
9 Fee Started y Approved y
BUILDING $
PLUMBING $
MECHANICAL $
ELECTRICAL $
OTHER $
VI. ADDITIONAL PERMITS REQUIRED OR OTHER JURISDICTION APPROVALS
Date D
Permit or Approval Check Obta ned Number By Permit or Approval Check Obtta t ed 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 rAli)—co
Building �' Use Group
Permit issued
Building Fire Grading
Permit Fee $ L�`V'� Live Loading
Certificate of Occupancy $ Occupancy Load
Approv d by:
Drain Tile $
Plan Review Fee $
TITLE
NOTES and Data — (For department use)
. tic+
CITY OF NORTHAMPTON
OFFICE OF THE INSPECTOR OF BUILDINGS
212 MAIN STREET APPLICATION FOR
NORTHAMPTON, MA. 01060 ;7 ���J PLAN EXAMINATION AND
BUILDING PERMIT
z
IMPORTANT — Applicant to complete all items in sections: 1, 11, 111, IV, and IX. O
ZONING
I• AT (LOCATION) DISTRIC f
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 rn
rn
1 New building Residential Nonresidential
2 Addition(If residential, enter number 12,S� 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
units ——————— — -i 22 ❑ Service station, repair garage
5 F-1 o Wrecking (If multifamily residential, ❑ f
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 — Specify 25 ❑ Public utility
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
processing plant, machine shop, laundry building at hospital, elementary
school, secondary school, college, parochial school, parking garage for,
10. Cost of improvement,,,,,,,,,,,•,,,,
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.............. G�
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
51. Enclosed ......................
F. PRINCIPAL TYPE OF HEATING FUEL I. TYPE OF MECHANICAL
35❑ Gas there be central air 52. Outdoors........................
36 X Oil condi 'oning? L. RESIDENTIAL BUILDINGS ONLY
37F-1 Electricity 44 ❑ Ye 45 ❑ No 53. Number of bedrooms..............
38 ❑ Coal
39❑ Other— Specify Will ther a an eleva 54. Number of Full..........
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 4 his
authorized agent.
SIGNATURE OF AGENT -`
ADDRESS
(NUMBER) (STREET) (CITY)
APPROVED BY TITLE
DATE 19
DEPT. FILE COPY
Zo
DEPARTMENT OF BUILDING INSPECTIONS BUILDINGa G
212 MAIN STREET a _ _
NOR.THL#TTONt MA. o1o6o PERMIT VALIDATION
17C — 159 Code #79
DATE October 17, Q ,g 79 PERMIT NO. 607
APPLICANT_ Susan l�nmon ADDRESS 78 Chestnut
(NO.) (STREET) (CONTR'S LICENSE)
NUMBER OF
PERMIT TO Gi'1imney & unod Gtoy L) STORY FOr Wood—burning stove DWELLING UNITS 1
(TYPE OF IMPROVEMENT) NO. (PROPOSED USE)
ZONING
AT (LOCATION) 78 Chestnut DISTRICT URB
(NO.) (STREET)
a BETWEEN AND
m (CROSS STREET) (CROSS STREET)
a
LOT
D' SUBDIVISION LOT BLOCK SIZE
m
a
0 BUILDING IS TO BE FT. WIDE BY FT. LONG BY FT. IN HEIGHT AND SHALL CONFORM IN CONSTRUCTION
O
m
O
Z TO TYPE USE GROUP BASEMENT WALLS OR FOUNDATION
f (TYPE)
LL REMARKS: — Install new block chimney for wood—burning stove
AREA OR PERMIT
VOLUME ESTIMATED COST . ron nn FEE
(CUBIC/SQUARE FEET)
J
OWNER Tgnn-i g RPn4nn
ADDRESS 78 Chestnut Street B DI r
B
(Affidavit on reverse side of application to be completed by authorized agent of owner)