17C-095 (7) VIII. ZONING PLAN EXAMINERS NOTES
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NOTES
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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.
Owner or
Lessee S ck T
Bui Ider's
L.
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
Plans Review Re wired Check Plan Review Date Plans B Date Plans B Notes
q Fee Started y Approved y
BUILDING
PLUMBING
MECHANICAL
ELECTRICAL $
OTHER
VI. ADDITIONAL PERMITS REQUIRED OR OTHER JURISDICTION APPROVALS
ate ate
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 - 7 G' Use Group
Permit issued f 19
Building c\ Fire Grading
Permit Fee s Live Loading
Certificate of Occupancy $ Occupancy Load
A ved by:
Drain Tile
Plan Review Fee
TITLE
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NOTES and Data — (For department use)
CITY OF NORTHAMPTON
OFFICE OF THE INSPECTOR OF BUILDINGS
212 MAIN STREET APPLICATION FOR
NORTHAMPTON, MA. 01060 l7 C-- Fl�� PLAN EXAMINATION AND
BUILDING PERMIT
IMPORTANT — Applicant to complete all items in sections: 1, 11, 111, IV, and IX. O
` 6 ZONING
I• AT (LOCATION) t��JJJ ZONING
LOCATION (NO.) (STREET)
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 im
M
1 ❑ New building Residential Nonresidential
2 Addition(If residential, enter number 12 One 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 ❑ Alteration (See 2 above) 14 l
l
h
i
Transent hotel, mote ,
❑ 21 ❑ Parking garage
4 ❑ 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 ❑ Garage 23 ❑ Hospital, institutional
Part D, 13) 16 ❑ Carport 24❑ Office, bank, professional
6 F-1 Moving Moving (relocation)
7 F__] Foundation only 17 Other — Specify 25 ❑ Public utility
26 ❑ School, library, other educational
B. OWNERSHIP l,1 'rr'w 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
Q^ ,l processing plant, machine shop, laundry building at hospital, elementary
10. Cost of improvement•.,.,,,,•....... ��J v� 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 $[ o UV
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..............
square feet of floor area
Total sq ,
31 Wood frame 41 ❑ Private (septic Tank, etc.) 49.
all floors, based on exterior
32 Structural steel dimensions .....................
33 ❑ Reinforced concrete H. TYPE OF WATER SUPPLY
34 F-1 Other — Specify 42 Public or private company 50. Total land area, sq. ft. ...........
43 N Private(well, cistern) K. NUMBER OF OFF-STREET
PARKING SPACES
F. PRINCIPAL TYPE OF HEATING FUEL I. YPE OF MECHANICAL 51. Enclosed ....................... /la-
35 ❑ Gas Wi here be central air 52. Outdoors........................ 1`l4
36 Oil candid ing? d !!!
L. RESIDENTIAL BUILDINGS ONLY
37 ❑ Electricity 44 ❑ Yes 45 ❑ No 53. Number of bedrooms..............
38 ❑ Coal
39 ❑ Other — Specify Will they a an elevat Full... ....
54. Number of
46 Yes 47❑ bathrooms Portia I. �....
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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_,app]ication as his -
authorized agent.
e�
SIGNATURE OF AGENT
ADDRESS
(NUMBER) (STREET) (CITY)
APPROVED BY TITLE
DATE 19
4<
DEPT. FILE COPY
DEPARTMENT OF BUILDING INSPECTIONS Z°
212 MAIN STREET p O<
BUILDING
NORTHAMPTONt MA. 01060 a
PERMIT VALIDATION
17C - 95 CODE #79
DATE Ma 7. 19 80 PERMIT NO. 230
APPLICANT Edward Kocot ADDRESS 136 Chestnut St.s Flo.
(NO.) (STREET) (CONTR'S LICENSE)
NUMBER OF
�t 1
PERMIT TO Add4 ion (yam) STORY Pnre-h DWELLING UNITS
(TYPE OF IMPROVEMENT) NO. (PROPOSED USE)
ZONING
AT (LOCATION) 136 Chestnut DISTRICT
(NO.) (STREET)
m BETWEEN AND
Q (CROSS STREET) (CROSS STREET) -
LOT
m SUBDIVISION LOT BLOCK SIZE
a Addition
U0 XXX= IS TO BE 18 FT. WIDE BY 20 FT. LONG BY FT. IN HEIGHT AND SHALL CONFORM IN CONSTRUCTION
M
Z TO TYPE USE GROUP BASEMENT WALLS OR FOUNDATION
I (TYPE)
K
0
w REMARKS:
AREA VOLUME ESTIMATED COST $ 1800.00 FEEMIT . 10.00
(CUBIC/SQUARE FEET)
OWNER FdwarA Ynrnt BUI I PT
r
St.,136 rbentnut g Florence. Mn- 01060 BY
(Affidavit on reverse side of application to be completed by authorized agent of owner)