29-247 (3) VIII. ZONING PLAN EXAMINERS NOTES
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USE
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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.
Owner or d 2 S
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 applicant Address Application date
00 NOT WRITE BELOW THIS LINE
V. PLAN REVIEW RECORD — For office use
Plan Review Date Plans Date Plans
Plans Review Required Check Fee Started By Approved By Notes
BUILDING $
PLUMBING $
MECHANICAL $
ELECTRICAL $
OTHER $
V1. ADDITIONAL PERMITS REQUIRED OR OTHER JURISDICTION APPROVALS
Dae Date
Permit or Approval Check Obta tned 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 .
Building Use Group
Permit issued q 19
Building / Fire Grading
Permit Fee $ ` 0'(n o Live Loading
Certificate of Occupancy $ Occupancy Load
Ap ed by:
Drain Tile $
Plan Review Fee $
TITLE
NOTES and Data — (For department use)
CITY OF NORTHAMPTON
OFFICE OF THE INSPECTOR OF BUILDINGS
212 MAIN STREET APPLICATION FOR
NORTHAMPTON, MA. 01060 19 ^ �� PLAN EXAMINATION AND
r
7 BUILDING PERMIT
IMPORTANT — Applicant to complete all items in sections: 1, 11, III, IV, and IX. O
ZONING
I• AT (LOCATION) 102 V DISTRICT
LOCATION (NO.) (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
A. TYPE OF IMPROVEMENT D. PROPOSED USE - For"Wrecking" most recent use m
M
1 U New building Residential Nonresidential
2 ❑ Addition(If residential, enter number 12;KOne 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 Tit hotel, motel,
Transient 21 ❑ Parking garage
4 F-1 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;K Garage 23 ❑ Hospital, institutional
Part D, 16❑ Car art 24 E] Office, bank, professional
6 ❑ Moving (relocation) p
7 ❑ Foundation only 17❑ Other - Specify 25 ❑ Public utility
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
^JO processing plant, machine shop, laundry building at hospital, elementary
10. Cost of improvement•,••••••,•,••••, J W 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 $3600--
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...............
31 Wood frame 41 Private (septic tank, etc.) 49. Total square feet of floor area, V�
x
all floors, based on exterior
32❑ Structural steel dimensions .....................
33 ❑ Reinforced concrete H. TYPE OF WATER SUPPLY
50. Total land area, sq. ft. ...........
34 F-1 Other - Specify 42 Public or private company
43 Private (well, cistern) K. NUMBER OF OFF-STREET
PARKING SPACES
F. PRINCIPAL TYPE OF HEATING FUEL I. PE OF MECHANICAL 51. Enclosed .......................
35 ❑ Gas Wi here be central air 52. Outdoors........................
36 ❑ Oil conditt ing?
L. RESIDENTIAL BUILDINGS ONLY
37 Electricity 44 ❑ Yes 45 ❑ No 53. Number of bedrooms..............
38 ❑ Coal
39 ❑ Other - Specify Will ther a an elevator? Full..........
54. Number of
46 ❑ Yes 47❑ No bathrooms
Partial.......
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
"f-� DEPT. FILE COPY
BUILDING �a
PERMIT
VALIDATION
09-.2 IC/7
1 PERM(
APPLICANT j ATE ADDRESS
9 NO.
(NO.) (STREET) (CONTR'S LICENSE)
NUMBER OF
PERMIT .STORY DWELLING UNITS
(TYPE OF IMPROVE ENT) NO. (PROPOSED USE)
ZONING
1Z
AT (LOCATION) d opeA OO r �'DR(y DISTRICT
(NO.) (STREET)
w BETWEEN AND
'o (CROSS STREET) (CROSS STREET)
w_
LOT
a SUBDIVISION LOT BLOCK SIZE
m
Q
U
O BUILDING IS TO BE FT. WIDE BY FT. LONG BY FT. IN HEIGHT AND SHALL CONFORM IN CONSTRUCTION
rQ
O
Z TO TYPE USE GROUP BASEMENT WALLS OR FOUNDATION
(TYPE)
LL REMARKS:
t?� �1�° �'ff' rte,° .'�• r� fa,, ^,�
VOLUME � ..�(fsr �7� ESTIMATED COST . ��— PERMIT l C�J
(CUBIC/SQUARE FEET)
^� f
OWNER zd
ADDRESS a BBYI
(Affidavit on reverse side of application to be completed by authorized agent of owner)