17C-234 (5) VIII. ZONING PLAN EXAMINERS jNOTES
DISTRICT )
IV
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 Mailing address — Number, street, city, and State ZIP code Tel. No.
j �t�Y-L3G
C)
C' 7i?i > '?° f ;�"!► l� Col ° c (
O t
Owner or (/
Lessee R-
l-��
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.
Signature of applic nt Address Application date
D0 NOT WRITE BELOW THIS LINE
V. PLAN REVIEW RECORD — For office use
Plans Review Required Check Plan Review Date Plans B y
Date Plans B Notes
q Fee Started y Approved
BUILDING
PLUMBING
MECHANICAL
ELECTRICAL
OTHER
VI. ADDITIONAL PERMITS REQUIRED OR OTHER JURISDICTION APPROVALS
Permit or Approval Check Date Number B Permit or Approval Check Date Number B
Pp Obtained y pp Obtained 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 C�
Building ��� / I9 Use Group
Permit issued
Building
�. Fire Grading
`,;-;
Permit Fee `l'` Live Loading
Occupancy Load
Certificate of Occupancy
Approved by:
Drain Tile
Plan Review Fee �r
LE
4
NOTES and Data — (For department use)
�f
CITY OF NORTHAMPTON
OFFICE OF THE INSPECTOR OF BUILDINGS Y,73
212 MAIN STREET t'% �. YAPPLICATION FOR
NORTHAMPTON, MA. 01060 / PLAN EXAMINATION AND
BUILDING PERMIT
IMPORTANT — Applicannttt to complete all items in sections: 1, 11, 111, IV, and IX. O
ZONING
I• AT (LOCATION) 3 DISTRICT
LOCATION (NO.) (STREET)
OF BETWEEN NO iyl I�ItA AND
BUILDING (CROSS STREET) (CROS STREET)
LOT
SUBDIVISION LOT BLOCK SIZE
H
II. TYPE AND COST OF BUILDING — All applicants complete Parts A — D
A. TYPE OF IMPROVEMENT D. PROPOSED USE - For"Wrecking" most recent use Im
M
1 ❑ New building ResidrIntial Nonresidential
2�NAddition(If 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 F-1 Alteration (See 2 above) 14 ❑ Transient hotel, motel, ❑
4❑ Repair, replacement 21 ❑ Parking garage
P P 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 X 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
tt��
�• - processing plant, machine shop, laundry building at hospital, elementary
10. Cost of improvement•,•••••••••••••• C"O. 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 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 j
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?
F
54. Number of ull.........
46 ❑ Yes 47❑ No bathrooms
Partial.......
°x
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'4
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C
Ali
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� j ��.. ,�: ",� h�`� ."_�n. ex ";�""`..? .,F �'�&�•,�5i>_ "�{ ? s+�. ��.:;pgP'1u*3t .., �•E��.<'.`e�,Af, ?,.,�.'�' ? 3'.� -
I hereby certify that the proposed work is authorized by the owner of record
and 1 have been authorized by the owner to make this application as his
authorized agent.
SIGNATURE -0F`A)GENT
ADDRESS
(NUMBER) (STREET) (CITY)
APPROVED 13 TITLE
DATE 19
DEPT. FILE COPY
DM. OF BUILDING INSPECTIONS
BUILDING 0a
212 Main Street PERMIT VALIDATION
Northampton, Mass. 01060 17C — 234
DATE November 15, 19 78 _ PERMIT NO. 566
APPLICANT PI J V r &I'd ADDRESS �; Rard3d9]1 St n
(NO.) (STREET) (CONTR'S LICENSE)
PERMIT TO Addition NUMBER OF
_ (�_) STORY Ga-rnO�'t: DWELLING UNITS 'L
(TYPE OF IMPROVEMENT) NO. (PROPOSED USE)
ZONING
AT (LOCATION) 3,3 Bardwell S DISTRICT t�B
(NO.) - (STREET) -
m BETWEEN Nn Mai n AND NO. Maple
m (CROSS STREET) (CROSS STREET)
a
LOT
a SUBDIVISION LOT BLOCK SIZE
m
U
O BUILDING IS TO BE 10 FT. WIDE BY 3—FT. LONG BY FT. IN HEIGHT AND SHALL CONFORM IN CONSTRUCTION
O]
O
2 TO TYPE USE GROUP BASEMENT WALLS OR FOUNDATION
2 (TYPE)
K
W REMARKS: Attached caxmort
AREA
OLUME ESTIMATED COST $ 100.00 FEEMIT 10.00
(CUBIC/SQUARE FEET) _
OWNER Oliver J Brassard
BUILDI G D Zf� ';_�&
ADDRESS 33 Bnrdw l l StreAt} Dormice, Ma.. BY
(Affidavit on reverse side of application to be completed by authorized agent of owner)