28-005 (5) ._�
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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 INTERNATIONAL, INC.
IV. IDENTIFICATION — To be completed by all applicants
Name Mailing address – Number, street, city, and State ZIP code Tel. No.
n.Owner or -�• .;e• �� l { '�. A v'-'C `�- �- n ( 1– l
t l�
Lessee
Builder's
2. Cry 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 � Addressssy 1 _( Application date
00 NOT WRITE BELOW THIS LINE
V. PLAN REVIEW RECORD — For office use
Plans Review Required Check Plan Review Date Plans B Date Plans By Notes
y
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
Building Use Group
Permit issued 19
�-
Building Fire Grading
Permit Fee $ Live Loading
Certificate of Occupancy $ Occupancy Load
Ap ed by:
f
Drain Tile $ f �
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 PLAN EXAMINATION AND
BUILDING PERMIT
IMPORTANT — Applicant to complete all/i't�ems in (sgections: 1, 11, 111, IV, and IX. o ZONIN
I• AT (LOCATION) _ ` \vim-`�✓�1 "•-- V° D STR CT/
LOCATION (NO.) (S REET)
OF BETWEEN AND
BUILDING (CROSS STREET) (CROSS STREET)
LOT
SUBDIVISION LOT BLOCK SIZE
N
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 Addition residential, enter number
L/J� f 12 One family 18 ❑ Amusement, recreational
of new housing units added, if an),
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 l
l
h
i
Transent hotel, mote ,
❑ 21 ❑ Parking garage
4❑ Repair, replacement or dormitory - Enter number
❑ 22 ❑ Service station, repair garage
5 Wrecking (1l 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 F-1 Moving Moving (relocation)
7 ❑ Foundation only 17 Other - Specify 25 ❑ Public utility
26 ❑ School, library, other educational
B. OWNERSHIP 27 ❑ Stores, mercantile
28 ❑ Tanks, towers
8X Private (individual, corporation, Specify
Other -
nonprofit institution, etc.) 29 ❑ p fy
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 X 0 N
.....................
33 ❑ Reinforced concrete H. TYPE OF WATER SUPPLY
34 El Other - Specify 42 F-1 Public or private company 50. Total land area, sq. ft. ...........
43*X 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 be central air 52. Outdoors........................
?d
conitioning
36� Oil L. RESIDENTIAL BUILDINGS ONLY J
37 ❑ Electricity 44❑ Yes 45 `y No 53. Number of bedrooms..............
38 ❑ Coal
39 ❑ Other - Specify Will there be on elevator? Full..........
54. Number of
46 ❑ Yes 47 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 ras .his s_
authorized agent.
SIGNATURE bF AGENT _
ADDRESS
(NUMBER) (STREET) (Cl TY)
APPROVED BY TITLE
DATE 19
�. F_ DEPT. FILE COPY
ZO
DEPARTMENT OF BUILDING INSPECTIONS BUILDING In.
212 Main street L^ PERMIT VALIDATION
Northampton, Ma. 01060
28 - 5 DATE April 4, 19 79 PERMIT NO. 104
APPLICANT Susan Routhier ADDRESS 394 Sy14P_ster Rd- ,Fl o-
(N0.)� (STREET) (CONTR'S LICENSE)
NUMBER OF
PERMIT TO Alter Residence STORY_ Addition DWELLING UNITS
(TYPE OF IMPROVEMENT) NO. (PROPOSED USE)
AT (LOCATION) 394 Sylvester Rd. ZONING
DISTRICT RR
(NO.) (STREET)-
o, BETWEEN AND
(CROSS STREET) (CROSS STREET)
a
LOT
ID- SUBDIVISION LOT BLOCK SIZE
Addition
u O IS TO BE 22 FT. WIDE BY 25 FT. LONG BY FT. IN HEIGHT AND SHALL CONFORM IN CONSTRUCTION
m
O
Z TO TYPE USE GROUP BASEMENT WALLS OR FOUNDATION
(TYPE)
O:
o REMARKS: Add�tlon - 2nd. floor - 3 bedroome added
AREA OR PERMIT
VOLUME 550 ESTIMATED COST $ 30000 FEE $ 10.00
(CUBIC/SQUARE FEET)
OWNER Louis F. & Susan Routhler
ADDRESS 3,Q?��yZvBgter Rd_ . IATEIICB, Ma- L
(Affidavit on reverse side of application to be completed by authorized agent of wner)