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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 e� d } r r � N 7 m� i� e t f € + p A 1 f E a �y w» 3 S e A 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 oil I