43-070 (3) DEBARMENT OF BUILDING INSPECTIONS C58`6— 3662 DEPT. FILE COPY
212 MAIN STREET BUILD!
NORTHAMPTON, MA, 01060 PERMIT
VA LIDATION
43 - 70 CODE # 79 CM
DATE December 3. 26 19 79 PERMIT NO. 690
APPLICANT nAvid ad Mr-Mad ADDRESS ( TniphyBTThrtve REET) ICoxin`z LICENSE)
PERMIT TO Chimmev & stove ) 2 1 STORY For wood burning stove NUMBER OF
(TYPE OF IMPROVEMENT) NO. (PROPOSER LIRE) DWELLING UNITS
ZOING
AT (LOCATION) limply Drive DISTRICT SR
1 O.) (STREET)
BETWEEN AND
(CROSS STREeTI - (CROSS STREET)
a.
LOT
Fro SUBDIVISION LOT BLOCK SIZE
O BUILDING IS TO BE FT. WIDE BY FT. LONG BY FT. IN HEIGHT AND SHALL CONFORM IN CONSTRUCTION
Z TO TYPE USE GROUP BASEMENT WALLS OR FOUNDATION
I (TYPE)
iSLL
REMARKS:46171.=-q TKn7 elq A(.a. nh'I Welq]r and ill R}Al1 el— nmi nQ stove in )1HgiDMT1'E_
ed,
AREA OR �r $ 700.00 FEEMIT Q. 'QR GG
VOLUME ESTIMATED COST V
ICVBIUSOUARE FEET)
Pi OWNER v el / �l /
ADDRESS 9FThlmphy Driva, NnTthH�ton� Ma 01060 v
(Affidavit on reverse side of application to be completed by authorized agent of owner(
I 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_.
, t
f
CITY OF NORTHAMPTON
OFFICE OF THE INSPECTOR OF BUILDINGS /�- ��
212 MAIN STREET / APPLICATION FOR
NORTHAMPTON, MA. 01060 PLAN EXAMINATION AND
BUILDING PERMIT
IMPORTANT — Applicant to complete all items in sections: I, II, III, IV, and IX. O
AT (LOCATION) e
Sy_ DIISTRICT S`1/\
LOCATION (no.1 1ST-ETI
OF BETWEEN ANL)
BUILDING (CROSS sTREETI (CROSS STREET)
LOT
SUBDIVISION LOT BLOCK SIZE
II. TYPE AND COST OF BUILDING — AU applicants complete Ports A — D -i
Pa
A. TYPE OF IMPROVEMENT D. PROPOSED USE - For"Wrecking" most recent use Irn
n
-I
-i
1 I I New building Residential Nonresidential
2 IXI Addition(If residential, enter number 12 One family 18I I Amusement, recreational
of new housing units added, if any, 13 Two or more family - Enter 19 religious
inPart D, 13) f 1 Church, other
3 Alterorl on (See 2 above) number of units- - - - -). 20 I I Industrial
14I I Transient hotel, motel, 21 I I Parkin
4I I Repair, replacement or dormitory - Enter number g garage
5 of units - y 22 I I Service station, repair garage
enternu (bf rot/hi/amity urn(S in rbuideng in
number urzi is building in 15 Garage 23 Hospital, institutional
Part D, 13)
6 I I Moving (relocation) 16 Carport — 24 Office, bank, professional
> Li Foundation only 1Z� Other - Specify t---civ"a"'-a/siz 25 I I Public utility
26I I School, library, other educational
B. OWNERSHIP 2ri22niiT/ ---i-,nw-wl-eYt/In�2)1 I Stores, mercantile
B.�Private (individual, corporation, - w .}- J�O 20 FII Tanks, towers
nonprofit institution, etc.) l`.('� o
-t -nta✓ r A../�y. . 29 Q Other - Specify
9 Li Public (Federal, State, or U
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 $ school, secondary school, college, parochial school, parking garage for
department store, rental office building, office building at industrial plant.
To he installed but not included If use of existing building is being changed, enter proposed use.
n the above cost
a. Electrical
b. Plumbing
c. Heating, air conditioning
d. Other(elevator, etc )
11. TOTAL COST OF IMPROVEMENT $ �6III;7171
III. SELECTED CHARACTERISTICS OF B ILDING - For new buildings and additions, complete Parts E - L;
for wrecking, complete only Port J, for all others skip to IV.
E. PRINCIPAL TYPE OF FRAME G. TYPE OF SEWAGE DISPOSAL J. DIMENSIONS `,
Masonry48. Number of stories rX -
30
�� (wall bearing) 40 I Public or private company
31 g 49 Total square feet of floor area,Wood frame 41 is{ Private (septic tank, etc.) all floors, based on exterior
32 I I Structural steel dimensions
33 I Reinforced concrete II. TYPE OF WATER SUPPLY
34 I Other - Specify 421 `1 Public or private company 50. Total land area, sq. ft
431 I Private(well, cistern) K. NUMBER OF OFF-STREET
PARKING SPACES
F. PRINCIPAL TYPE OF HEATING FUEL I. TVP •F MECHANICAL SL Enclosed
35 I I Gas Will there .. central air 52. Outdoors
36 I I Oil conditioning?
L. RESIDENTIAL BUILDINGS ONLY
37 \ Electricity 44 LJ Yes 45I I No 53. Number of bedrooms
38 Coal
39 I I Other- Specify Will ther. .0 an elevator? { /
54. Number of Full
46 IIS yes 471 I No bathrooms
Pa t'al
NOTES and Data - (For department use) // ��„ C
4d
IV. IDENTIFICATION — To be completed by all applicants
Name Moiling address — Number, tweet rite. and state ZIP code Tel. No.
Owner or ' ir-✓.xt.4io- dC �2rY�...,z� J 8-6 —
Lessee p �J36C�
Licenser 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 jun sdi ction.
Signature pplicant A I Address Application dote
DO 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 $
VI. ADDITIONAL PERMITS REQUIRED OR OTHER JURISDICTION APPROVALS
Dote 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 ��D FOR DEPARTMENT USE ONLY
Permit number
Building Use Group
Permit issued (-5\ 19,9
Building Fire Grading
Permit Fee $ /7'. Cir Live Loading
Certificate of Occupancy $ Occupancy Load
$ APPbr: P
Drain Tile /ht,V✓//, /����
Plan Review Fee $
TITLE
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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B OCA FORM APEOP - 669 C1969 OIIILDINF OFFICIALS & CODE ADMINISTRATORS I lERNATIOMAL, INC.