17A-251 (3) 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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BOLA FORM APEBP — 669 C1969 BUILDING OFFICIALS & CODE ADMINISTRATORS INTERNATIONAL, IN
C�Z . _
IV. IDENTIFICATION — To be completed by all applicants
Name /p Mailing address — Number, street, city, and State ZIP code Tel. No.
Owner or do� c L L Lb ` ` Q 10bo 5i4 t 3�
Lessee + O
L— Builder's
2 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 pli pnt Address Application date
o h,46 To IV
D0 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
9 Fee Started y Approved y
BUILDING
PLUMBING
MECHANICAL
ELECTRICAL
OTHER
VI. ADDITIONAL PERMITS REQUIRED OR OTHER JURISDICTION APPROVALS
Date Permit or Approval Check Obtaned 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 of �
Building Use Group
Permit issued � /�,�.<--�.�i.' 1 1. 19
Building f� 1 �� L�-- Fire Grading
Permit Fee / J� Live Loading
Certificate of Occupancy $ Occupancy Load
Approved by:
Drain Tile $
Plan Review Fee
TITL
NOTES and Data — (For department use)
CITY OF NORTHAMPTON
OFFICE OF THE INSPECTOR OF BUILDINGS
212 MAIN STREET APPLICATION FOR
NORTHAMPTON, MA. 01060 17 PLAN EXAMINATION AND
� BUILDING PERMIT
z
IMPORTANT — Applicant to complete all items in sections: I, 11, 111, IV, and IX. O
ZONING
1• AT (LOCATION) /� DISTRICT/
LOCATION ( ) (STREET)
OF BETWEEN AND
BUILDING (CROSS STREET) (CROSS STREET)
LOT
SUBDIVISION LOT BLOCK SIZE
N
11. TYPE AND COST OF BUILDING — A11 applicants complete Parts A — D
A. TYPE OF IMPROVEMENT D. PROPOSED USE - For"Wrecking" most recent use M
m
1 ❑ New building Re dential Nonresidential
2 ❑ Addition(If residential, enter number 12XOne 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)
140 Transient hotel, motel,
4 ❑ Repair, replacement 21 ❑ Parking garage
p p or dormitory - Enter number
5 F-1 Wrecking (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) ❑
❑ Office, bank, professional
6 F-1 Moving (relocation) 16 Carport 24
17❑ Other - Specify 25 ❑ Public utility
7 ❑ Foundation only
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,,,.,..•.....• r 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.....................
A
b. Plumbing .....................
c. Heating, air conditioning..........
d. Other (elevator, etc.)............
11. TOTAL COST OF IMPROVEMENT 1$
III. SELECTED CHARACTERISTICS OF BU LDING — 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 F SEWAGE DISPOSAL J. DIMENSIONS r/I
30❑ Masonry (wall bearing) 40 Public or private company 48' Number of stories....,l..._z_1_:
31 Wood frame 41 ❑ Private (septic tank, etc.) 49. Total square feet of floor area,
all floors, base n,,.+gxte
3 ❑ Structural steel dimensions .. ..�^. ..
33 ❑ Reinforced concrete H. T PE OF WATER SUPPLY
34 F-1 Other - Specify 42 Public or private company 50. Total land area, sq. ft. ...........
4 ❑ Private (well, cistern) K. NUMBER OF OFF-STREET
PARKING SPACES
51. Enclosed .......................
F. PRINCIPAL TYPE OF HEATING FUEL I. TYPE OF MECHANICAL
35VGas Will there be central air 52. Outdoors....................
conditioning?
36 ❑ oil L. RESIDENTIAL BUILDINGS 0
37 F-1 Electricity 44 ❑ Yes 45No 53. Number of bedrooms...........`.....
38 ❑ Coalj
39 F-1 Other - Specify Will there be an elevator? //� Full....�.....
54. Number of
46 ❑ Yes No bathrooms
I — — ?� I Partial.......
p i
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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 OF AGENT
ADDRESS
(NUMBER) (STREET)- (CITY)
APPROVED BY TITLE
DATE 19
DEPT. FILE COPY
CITY OF NORTHAMPTON O-D
.- RMA1vPTON, MA. 17A-251 BUILDING Qa
PERMIT VALIDATION
DATE jime 21 , 19 78 PERMIT NO. 248
APPLICANT John Tyciaq ADDRESS 114 hake Street, Flo.
(NO.) (STREET) (CONTR'S LICENSE)
1 NUMBER OF 1
PERMIT TO_A� rg4i rip-nop (0-) STORY Residence DWELLING UNITS
(TYPE OF IMPROVEMENT) N (PROPOSED USE)
ZONING
AT (LOCATION) 114 Lake DISTRICT
(NO.) (STREET)
(STREET)
0. BETWEEN AND (
(CROSS STREET) CROSS STREET)
LOT
n SUBDIVISION LOT BLOCK SIZE
m
' t
U
O BUILDING IS TO BE FT. WIDE BY FT. LONG BY FT.4.IN HEIGHT AND SHALL CONFORM IN CONSTRUCTION
' .
Z TO TYPE USE GROUP BASEMENT WALLS OR F9,UNDATION
.� (TYPE)
° REMARKS: LIter residence per plans on file
AREA OR PER MIT
VOLUME ESTIMATED COST $ 4,Z.50_nn FEE $ 15.00
(CUBIC/SQUARE FEET)
OWNER John & Priscilla Lyons
BaDINDEPT
ADDRESS T kp, StY'PPty Florence Ma B
(Affidavit on reverse side of application to be completed by authorized agent of owner)