35-059 (8) VIII. ZONING PLAN EXAMINERS NOTES
DISTRICT
USE
FRONT YARD f /
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.
Owner or E
Lessee
Bui Ider's
L. License No.
Contractor
M
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
Plans Review Required Check Plan Review Date Plans By Date Plans By Notes
Fee Started Approved
BUILDING
PLUMBING
MECHANICAL
ELECTRICAL Is
OTHER Is
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
Building g Use Group
Permit issued ttL_ .195?x� _
Building Fire Grading
Permit Fee $�/�_ Live Loading
Certificate of Occupancy $ Occupancy Load
Approved by:
Drain Tile
Plan Review Fee
1 TLE
i >
NOTES and Data — (For department use)
a
CITY OF NORTHAMPTON
OFFICE OF THE INSPECTOR OF BUILDINGS
212 MAIN STREET f APPLICATION FOR
NORTHAMPTON, MA. 01060 �F� �3� �--,� PLAN EXAMINATION AND
BUILDING PERMIT
IMPORTANT — Applicant to complete all items in sections: 1, 11, 111, IV, and IX. O
ZONING
I• AT (LOCATION) �'�.� - DISTRICT
LOCATION �f NO.) (ST T)
OF BETWEEN AND
BUILDING (CROSS STREET) (CROSS STREET)
LOT
SUBDIVISION LOT BLOCK SIZE
Vr
II. 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;R'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 Transient motel,❑ T it hotel, tl 21 ❑ Parking garage
4 ❑ Repair, replacement or dormitory — Enter number
5 ❑ Wrecking (If multifamily residential, of units ——————— — -i 22 ❑ Service station, repair garage
enter number of units in building in 15 ❑ Garage 23 ❑ Hospital, institutional
Part D, 13) ❑ Carport 24 Office, bank, professional
6 ❑ Moving (relocation) 16 p ❑
7 ❑ Foundation only 17�Other — Specify 25 ❑ Public utility
26 ❑ School, library, other educational
B. OWNERSHIP 12214 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
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) 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)K�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 b central air 52. Outdoors........................
36 Oil conditioning^anelevato L. RESIDENTIAL BUILDINGS ONLY
37❑ Electricity 44 ❑ ❑ No 53. Number of bedrooms..............
38 ❑ Coal
39 F-1 Other — Specify Will the ? 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 hit'
authorized agent.
SIGNATURE"01= AGENT`
ADDRESS
(NUMBER) (STREET) (CITY)
APPROVED BY TITLE
DATE 19
DEPARTMENT OF BUILDING INSPECTIONS DEPT. FILE COPY
212 MAIN STREET z°
NORTHAMPTON9 MA. 01060 BUILDING
35 - 59 PERMIT VALIDATION
DATE junp 187 19 80 PERMIT NO. _314
APPLICANT Wi.l].iam Hubbard ADDRESS $Ox 166 Flt>retzce- Ma.
(NO.) (STREET) (CONTR'S LICENSE)
PERMIT TO Addi tijon ( ) STORY Gb V & �� 4 NUMBER OF
(TYPE OF IMPROVEMENT) N0. imne pR stove DWELLING UNITS 1.
ZONING
AT(LOCATION) (NO.) {STREET 932 ")Road DISTRICT— SR
-
rn BETWEEN AND
(CROSS STREET) (CROSS STREET)
a LOT
m SUBDIVISION LOT BLOCK SIZE
a
u
O BUILDING IS TO BE FT. WIDE BY FT. LONG BY FT. IN HEIGHT AND SHALL CONFORM IN CONSTRUCTION
M
O
Z TO TYPE USE GROUP BASEMENT WALLS OR FOUNDATION
f
K (TYPE)
u- REMARKS: Construct exterior masonaU chimney and install wood-burning stove
AREA OR PERMIT
VOLUME ESTIMATED COST I FEE 10 r00
(CUBIC/SQUARE FEET)
OWNER William & Sandra Hubbard BUI ING EPT.
ADDRESS Box 166_ Flnrence- Ma- Q,1060 BY
(Affidavit on reverse side of application to be completed by out orized agent of owner)