17A-155 (4) VIII. ZONING PLAN EXAMINERS NOTES
DISTRICT [ �/
USE
FRONT YARD /
SIDE YARD SIDE YARD
REAR YARD
NOTES Y ,� s 'i . mot. _I"
IX. SITE OR PLOT PLAN — For Applicant Use
k t xa
.taa �w�r " ." kg'b'..� p,W
+
E fps r -� r } �11 d�` e as a �i '' 3 rs z
s Uzi - m �a
� � r. , �
x
v .
p d
f 4
� dea i t f i 2 a 1 >}YYY
4 ¢ t ,
P c i
tt
-T-Pmt'--'- 5 d ,a y I T,
,a.ay�§g-' ! � p �d -{¢ ' g-ah$ 6,.,..w.K° d d-� d-g� +.+w-�a ,�t L� I �,- a ,. ,
}} -k.L t .p 4 *iq
� f �§
t nifi, 9¢-t
Lit
�§ r �-� 1 ?k a-r -J
j t
�1 ..
a�'�. A
r# t 1
}, a
4_1
��r"'r�p g-¢l-r���3t„,i...,,...»�,�-wrre,-�m4 r�•?i,�w;r_�a-°r -�;4 r'�{T-�a a+--
1-4-47,+�.§»P-..t§.¢r
.E c aa�
y
t+ -a r T; } -
p + 44
.�.
kd_L
§sS
-�+-
:71 fi f t ff f ,+41 r .+t to- z -114 i? - } a,
-- -r
.--k.-_
-
a� =9 3”$� k . a 4
RsW r
! A T-11, 1,41
1 }9 't -i-.
;4-1
z
-
.§b.`-::�:
-
1 S`a'
'.a 4a r , xo 7.�'g s
z f ' ,-ii iJ tr % #
t p r+
11Z1 4
4.
'
i
r s } x r P v T7 i'' -t i._ z +° t
it
¢B v.§ .�--i ? i E.° ,.: .., d '°f t¢ ate- �� $m-.,t• § 6�-
..,o-
BOCA FORM APEBP — 669 C1969 BUILDING OFFICIALS & CODE ADMINISTRATORS INTERNATIONAL, INC. / �/7 �6'`< —7 7�� ,
IV. IDENTIFICATION — To be completed by all applicants
Names Mailing address — Number, street, city, and State ZIP code Tel. No.
Owner or
Lessee f
Builder's
2. �t /.< r `� 1 l,"rn .<l. Ca j } 1 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 applant Addres Application date 7
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 Is
OTHER Is
V1. 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 3 FOR DEPARTMENT USE ONLY
Permit number �(
Building ° - _�' r t /r Use Group
Permit issued - 19 /
Building �" Fire Grading
G
Permit Fee $ Live Loading
Certificate of Occupancy $ Occupancy Load
Approved by:
Drain Tile $
Plan Review Fee
TI
NOTES and Data — (For department use) ~
!' � ! -
i
t
f
CITY OF NORTHAMPTON
OFFICE OF THE INSPECTOR OF BUILDINGS
212 MAIN STREET APPLICATION FOR
NORTHAMPTON, MA. 01060 _ — PLAN EXAMINATION AND
014 — j 1� 1� BUILDING PERMIT
z
IMPORTANT — Applicant to complete all items in sections: 1, 11, 111, IV, and IX. 0
ZONING
DISTRICT,
I• AT (LOCATION) -
LOCATION (NO.') (,STREET)
OF BETWEEN (CROSS STREET)
BUILDING (CROSS STREET) AND
LOT
SUBDIVISION LOT BLOCK SIZE
H
II. TYPE AND COST OF BUILDING — All applicants complete Parts A — D
M
A. TYPE OF IMPROVEMENT D. PROPOSED USE - For"Wrecking" most recent use 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, 13 ❑ wo or more family - Enter 19 ❑ Church, other religious
in Part D, 13)
number of units- - - - --> 20 ❑ Industrial
3 ' Alteration (See 2 above) 14 ❑ Transient hotel, motel,
21 ❑ Parking garage
4 ❑ Repair, replacement or dormitory - Enter number
5 E] Wrecking (If multifamily residential,
of units ------- - -d• 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 r_-] g (relocation)relocation) 17 ❑ Other - SpeciJy 25 ❑ Public utility
7 ❑ Foundation only 26 ❑ School, library, other educational
B. OWNERSHIP 27 ❑ Stores, mercantile
28 ❑ Tanks, towers
8 Private (individual, corporation,
nonprofit institution, etc.) 29 Other - SpeciJy
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. TYEOF SEWAGE DISPOSAL J. DIMENSIONS
48. Number of stories................
30 Masonry (wall bearing) 40 ublic or private company
49. Total square feet of floor area,
31 Wood frame 41 ❑ Private (septic tank, etc.) all floors, based on exterior
32 Structural steel dimensions .....
33 ❑ Reinforced concrete H. TY E OF WATER SUPPLY 50. Total land ores, sq. t. ...........
�^
34 F-1 Other - Specify 4 Public or private company
f
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................,1.r- ...
conditioning?
36 Oil L. RESIDENTIAL BUILDINGS ONLY
37 Electricity 44❑ Yes 45 No 53. Number of be o
❑ coal "'�`. /�-(
39❑ Other - Specify Will there be an elevator? Full......
54. Number �f
bathrooms
46❑ Yes 47 No Partial........
hereby certify that the proposed work is authorized by the owner of record`
and 1 have been authorized by the owner to make this application as .has
authorized agent. a
SIGNATURE OF AGENT
ADDRESS
(NUMBER) (STREET), (CITY)
APPROVED BY TITLE
DATE 19
Y
DEPT. FILE COPY
DEPARTMENT OF BUILDING INSPECTIONS Zo
Z0
212 MAIN STREET BUILDING _n a.
NORTHAMPTON, MA. 01060 PERMIT 1'C VALIDATION
17A • 155 CODE #79
DATE .Tune 3, is 80 PERMIT NO. 283
APPLICANT Rir-harA Cnvo-11 ADDRESS 72 FAX Farms Rd.
(NO.) (STREET) (CONTR'S LICENSE)
PERMIT TO Alteration (-2—) STORY Al terat NUMBER OF
�An DWELLING UNITS 1
(TYPE OF IMPROVEMENT) NO. (PROPOSED USE)
ZONING
AT (LOCATION) 72 FAX Farms Rd. DISTRICT URA
(NO.) (STREET)
a BETWEEN AND
'D (CROSS STREET) (CROSS STREET)-
. �
LOT
D SUBDIVISION LOT BLOCK SIZE
m
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
(TYPE)
O:
o REMARKS: Add bass inrinm in Mining rnnm rgAr- Enclose existing back porch & breezeway,
front rear.
AREA OR PERMIT
VOLUME ESTIMATED COST $ nn FEE $ 12.00
(CUBIC/SQUARE FEET) �/
OWNER Richard CnvAll BBYILII .
ADDRESS 72 FAX Farms Rd.i N'ton-
(Affidavit on reverse side of application to be completed by authorized agent of owner)