35-209 (6) 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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BOCA FORM APEBP — 669 C1969 BUILDING OFFICIALS & CODE ADMINISTRATORS INTERNA IONAL, INC.
IV. IDENTIFICATION — To be completed by all applicants
Name Mailing address — ;Vurnbc•r, strcc°t, city, and State ZIP code Tel. No.
2p V Y WS
Owner or
Lessee
2. Builder's
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.
Signatu of applica t Address Application dots
00 NOT WRITE BELOW THIS LINE
V. PLAN REVIEW RECORD — For office use
Plans Review Required Check Plan Review Date Plans B Date Plans B Notes
Fee Started y Approved y
BUILDING $
PLUMBING $
MECHANICAL $
ELECTRICAL $
OTHER $
VI. ADDITIONAL PERMITS REQUIRED OR OTHER JURISDICTION APPROVALS
Permit or Approval Check Date Number By Permit or Approval Check Date Number B
Obtained 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 13// FOR DEPARTMENT USE ONLY
Permit number
Building /� Use Group
Permit issued 11Y1-2_�r—�7�� 19F—/—_
Building / Fire Grading
Permit Fee $ .�®
Live Loading
Certificate of Occupancy $ Occupancy Load
Approved by:
Drain Tile $
Plan Review Fee $
TITLE
NOTES and Data — (For department use)
DEPT. OF BUILDING INSPECTIONS
212 Main§treet
Northampton, Mass, 01060
APPLICATION FOR
PLAN EXAMINATION AND
BUILDING PERMIT
IMPORTANT — Applicant to complete all items in sections:sections: 1, 11, 111, IV, and IX. O
ZONING
I• AT (LOCATION) 3t yV�S�kA-v'o7o V, ITV A_Cl DISTRICT
LOCATION (NO.) (STREET)
OF BETWEEN AND
BUILDING (CROSS STREET) (CROSS STREET)
LOT
SUBDIVISION LOT BLOCK SIZE
to
II. TYPE AND COST OP BUILDING — All applicants complete Parts A — D
A. TYPE OF IMPROVEMENT D. PROPOSED USE — For"Wrecking" most recent use m
m
1 New building R idential Nonresidential
2 Addition(If residential, enter number 12One family 18 ❑ Amusement, recreational
of new housing units added, if any, 13 ❑ Two or more family — Enter 19 ❑ Church, other religious
in Part D, 13) number of units— — — — -->.
3 ❑ Alteration (See 2 above) 2 ❑ Industrial
14 ❑ Transient hotel, motel, 21 1 ❑ 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)
1 7V Other — Specify 25 ❑ Public utility
7 ❑ Foundation only
26 ❑ School, library, other educational
B. OWNERSHIP 27 ❑ Stores, mercantile
8 u 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.)............. �1
11. TOTAL COST OF IMPROVEMENT I$ Old
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. T PE 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 o
2 exterior
❑ ructural steel dimensions . �a ...
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
51. Enclosed .....................
F. PRINCIPAL TYPE OF HEATING FUEL I. TYPE OF MECHANICAL
35❑ Gas Will there be central air 52. Outdoors........................
conditioning?
36 ❑ Cil L. RESIDENTIAL BUILDINGS ONLY
37❑ Electricity 44 ❑ Yes 45 )rNo 53. Number of bedrooms..............
36 ❑ Coal
39❑ Other — Specify Will there be an elevator? Full..........
54. Number of
46 ❑ Yes 47 No bathrooms
Partial.......
DEPARTMENT OF BUILDING INSPECTIONS
212 MAIN STREET
WRTHAMPTON, 01060 BUILDING 6/ Iv
PERMIT q-
35 - 209 !
VALIDATION
DATE_ j nP 29l-19 At PERMIT NO. 411
APPLICANT T onnar i Ymrrnc,S ADDRESS
IN 0.) (STR T) (CONTR'S LICENSE)
NUMBER OF
PERMIT TO M (—J_) STORY_ (PROP SE) DWELLING UNITS 1_
(TYP F A EMF.NT) N0. O D U
ZONING
AT (LOCATION) DISTRICT -SR
(NO. (STREET)
BETWEEN AND
(CROSS STREET) (CROSS STREET)
LOT
SUBDIVISION LOT BLOCK SIZE
BUILDING IS TO BE ',Q FT. WIDE BY 1Q --FT. LONG BY FT. IN HEIGHT AND SHALL CONFORM IN CONSTRUCTION
TO TYPE USE GROUP BASEMENT WALLS OR FOUNDATION
(TYPE)
REMARKS: Construction of accessory hed -
AREA OR ESTIMATED COST $ 500,00 FEEMIT 10.00
VOLUME
(CUBIC/SQUARE FEET) f
OWNER T Pnrard Yarrnys BUILD G D T
ADDRESS . 5 39 WPgtha=tn-n Rd_ . NO thamliOtQ$,,_Ma 01060 By
WHITE - FILE COPY . GREEN - FIELD COPY CANARY - APPLICANT CD1 PINK - ASSESSORS COPY
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