17A-229 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 01969 BUILDING OFFICIALS & CODE ADMINISTRATORS INTERNATIONAL, INC.
IV. IDENTIFICATION — To be completed by all applicants
Name Mailing address — Number, strut, city, and State ZIP code Tel. No.
1.
Owner or
Lessee
Builder's
2. Jil License No.
Contractor
Architect t;
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 Required Check Plan Review Date Plans B Date Plans By Notes
Fee Started y Approved
BUILDING
PLUMBING
MECHANICAL
ELECTRICAL
OTHER
VI. ADDITIONAL PERMITS REQUIRED OR OTHER JURISDICTION APPROVALS
Date )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 i Use Group
Permit issued 4Z 19/
Building /` Fire Grading
Permit Fee $ v ' Live Loading
Certificate of Occupancy Occupancy Load
Appr7d by:
�l
Drain Tile
Plan Review Fee
TITLE
r '
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
�� 2,2_ BUILDING PERMIT
z
IMPORTANT — Applicant to complete all items in sections: 1, 11, 111, IV, and IX. 0
��4 ( 7° ZONING ��2
I• AT (LOCATION) ,? �J Z DISTRICT
LOCATION (N0.) (STREET)
OF t yJ//� �C �%� °3S
BETWEEN l:� /1( AND
BUILDING iz (CROSS STREET) (CROSS STREET)
LOT
SUBDIVISION LOT BLOCK SIZE
V►
II. TYPE AND COST OF BUILDING — All applicants complete Parts A — D
X
A. TYPE OF IMPROVEMENT D. PROPOSED USE — For"Wrecking" most recent use M
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 /1 19 ❑ Church, other religious
3 ❑ Alteration (See 2 above)
number of units— — — — -- 20❑ Industrial
14 Transient hotel, motel, 21 ❑ Parking garage
4 ❑ Repair, replacement or dormitory — Enter number
5 KWrecking (If multifamily residential, of units ——————— — -i 22 ❑ Service station, repair garage
enter number of units in building in 15 Garage 23 ❑ Hospital, institutional
Part D, 13) r❑
16 l Carport 24 ❑ Office, bank, professional
6 ❑ Moving (relocation)
7 ❑ Foundation only 17�❑ Other — Specify 25 ❑ Public utility
26 ❑ School, library, other educational
B. OWNERSHIP 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
processing plant, machine shop, laundry building at hospital, elementary
10. Cost of improvement•,,,,•••••,,,,,• 4 >, school, secondary school, college, parochial school, parking garage for,
department store, rental office building, office building of 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..................... 140X tl- C_�1`/ C //7(i '✓(�%C Cf /r1Ci
b. Plumbing .....................
c'cw S
c. Heating, air conditioning..........
d. Other (elevator, etc.)............ A_"11 1 Cl ifi L'
11. TOTAL COST OF IMPROVEMENT $ ao'Gr�
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 ..................... 1 /�
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
F. PRINCIPAL TYPE OF HEATING FUEL I. TYPE OF MECHANICAL 51. Enclosed ......................
35 XGos Will there be central air 52. Outdoors........................
36 conditioning? L. RESIDENTIAL BUILDINGS ONLY
37 44 ❑ Yes 45 ❑ No 53. Number of bedrooms..............
38 39 Will there be on elevator? Full..........
54. Number of
46 ❑ Yes 47❑ No bathrooms
Partial.......
t ;
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 application, as his
authorized agent.
SIGNATURE-OP AGENT
ADDRESS
(NUMBER) (STREET) (CITY)
APPROVED BY TITLE
DATE 19
. , DEPT. FILE COPY
ZO
CITY OF NORTHAMPTON BUILDING a a
PERMIT VALIDATION
NORTHAMPTON, MA. 17A — 229
DATE July 12, 19 78 NO. 276
APPLICANT Robert M Beaimre ADDRESS 101 & 103 Lake Street
(NO.) (STREET) (CONTR'S LICENSE.)
NUMBER OF
PERMIT TO Demolition cg CnY14tY=(_f_) STORY Aux Bldg DWELLING UNITS 2
(TYPE OF IMPROVEMENT) NO. (PROPOSED USE)
ZONING
Lake St P+l n T URB
AT (LOCATION) 10 y DISTRICT
�
(N0.) (STREET)
a BETWEEN North Maple AND 0 k
b (CROSS STREET) (CROSS STREET)
LOT
a SUBDIVISION LOT BLOCK SIZE
m
U BUILDING IS TO BE 12 FT. WIDE BY 12 FT. LONG BY FT. IN HEIGHT AND SHALL CONFORM IN CONSTRUCTION
m
Z TO TYPE USE GROUP BASEMENT WALLS OR FOUNDATION
� (TYPE)
0:
LL REMARKS; Demolition of existing building and const of steel aux building
AREA OR 'I PERMIT
VOLUME 144 4 ESTIMATED COST $ 4=DE FEE
(CUBIC/SQUARE FEET)
OWNER Rnb px� + Real re .ADDRESS 101 & 10� Take St,� Fl nrenre
(Affidavit on reverse side of application to be completed by authorized agent of owner)