29-229 (3) VIII. ZONING PLAN EXAMINERS NOTES' -
DISTRICT
USE /
FRONT YARD
SIDE YARD ��' .._ SIDE YARD
REAR YARD
NOTES
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BOLA FORM APEBP — 669 C1969 BUILDING OFFICIALS & CODE ADMINISTRATORS INTERNATIONAL, INC. `���"i.���.% /���4
IV. IDENTIFICATION — To be completed by all applicants
Name Mailing address — Number, street, city, and State ZIP code Tel. No.
Owner or J `
d�Lessee
( _ Builder'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 t Address Application date
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 $
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 n!
Building Use Group
Permit issued 6_ ,,� 19 _
Building Fire Grading
Permit Fee $ z0_ ea
Live Loading
Certificate of Occupancy $ Occupancy Load
Approved by:
Drain Tile $
Plan Review Fee $ ' /
NOTES and Data — (For department use)
i�
CITY OF NORTHAMPTON
OFFICE OF THE INSPECTOR OF BUILDINGS
212 MAIN STREET ! ��° ,� _�21 APPLICATION FOR
NORTHAMPTON, MA. 01060 PLAN EXAMINATION AND
BUILDING PERMIT
IMPORTANT — Applicant to complete all items in sections: 1, 11, 111, IV, and IX. O
ZONING
1• AT (LOCATION) t �"y �'a•`. �j I' DISTRICT
LOCATION (NO.) (STREET)
OF BETWEEN AND
BUILDING (CROSS STREET) (CROSS STREET)
LOT
SUBDIVISION LOT BLOCK SIZE
N
11. 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 New building Residential Nonresidential
2 Addition(IJ residential, enter number 12 One family 18 ❑ Amusement, recreational
of new housing units added, if any,
in Part D, 13) 13 F-1 Two or more family — Enter 19 ❑ Church, other religious
number of units— — — — � 20❑ Industrial
3 F-1 Alteration (See 2 above) 14 l
l
h
i
Transent hotel, mote ,
❑ 21 ❑ Parking garage
4 ❑ Repair, replacement or dormitory — Enter number
22 ❑ Service station, repair garage
5 ❑ Wrecking (If multifamily residential, of units ——————— — --� P 9 9
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 [__j Other — SpeciJy 25 ❑ Public utility
7 ❑ Foundation only
26 ❑ School, library, other educational
B. OWNERSHIP 27 ❑ Stores, mercantile
❑
8� Private (individual, corporation, 28 Tanks, towers eci Other — S
nonprofit institution, etc.) 29 ❑ Specify
9 ❑ Public (Federal, State, or
local government)
C. COST (Omit cents) Nonresidential — Describe in detail proposed use of buildings, e.g., food
f 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.)............
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) 49,� 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 �4erior
32 Structural steel dimensions ..... [..
33❑ Reinforced concrete H. TYPE OF WATER SUPPLY
34 F-1 Other — Specify 42,�K 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 Will there be central air 52. Outdoors........................
36 Oil conditioning?
L. RESIDENTIAL BUILDINGS ONLY
37❑ Electricity 44❑ Yes 45ANo 53. Number of bedrooms..............
38 ❑ Coal
39❑ Other — Specify Will there be an elevator? Full..........
54. Number of
46 ❑ Yes 47,k 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 his
authorized agent.
SIGNATURE OF AGENT`
ADDRESS
(NUMBER) (STREET) (CITY)
APPROVED BY TITLE
DATE 19
DEPT. FILE COPY
za
DEPARTMENT OF
MAIN STREET BUILDING INSPECTIONS f ' a D Af '2a
NORTHAMPTON, MA.. o1o6o PERMIT(
VALIDATION
29 - 229 p
DATE Jllne 18, 19_ 79 PERMIT NO. 298
APPLICANT Dm3gl a.S T- NPbert ADDRESS 176 Ann brook Drive
(NO.) (STREET) (CONTR'S LICENSE)
NUMBER OF
PERMIT TO Addii-.inn (_ I STORY- Dining - Sim room DWELLING UNITS 1
(TYPE OF IMPROVEMENT) NO. (PROPOSED USE)
AT (LOCATION) ti Acre ZONING
}�Y'QCl}C IkY'1Vp DISTRICT URA
IN _ (STREET)
rn BETWEEN AND
m (CROSS STREET) (CROSS STREET)
01
IL LOT
M SUBDIVISION LOT BLOCK SIZE
a Addition
p I IS TO BE 12 FT. WIDE BY 16 FT. LONG BY FT. IN HEIGHT AND SHALL CONFORM IN CONSTRUCTION
O
Z TO TYPE USE GROUP BASEMENT WALLS OR FOUNDATION
(TYPE)
K
REMARKS: Addition for dining area and sun room
AREA OR PER MIT
VOLUME 19P ESTIMATED COST $ 2590. FEE $ 10.00
(CUBIC/SQUARE FEET)
OWNER __ _ Doug.Zas L. HebErt �
ADDRESS 176 Ae-rebrook Drive, 1\Tnrt'hn ton BYILDI G aP f�
(Affidavit on reverse side of application to be completed by authorized agent of owner)