17C-174 (5) VIII. ZONING PLAN EXAMINERS NOTES
DISTRICT
USE Tel
FRONT YARD
SIDE YARD )"�� SIDE YARD
REAR YARD *
NOTES
IX. SITE OR PLOT PLAN — For Applicant Use
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41 L IL
BOCA FORM APEBP — 669 01969 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.
'ii• / J��.y�try a a r ,� EX
Owner or
Lessee
Builder's
2, p A%� ,r, 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
DO NOT WRITE BELOW THIS LINE
V. PLAN REVIEW RECORD — For office use
Plan Review Date Plans Date Plans
Plans Review Required Check Fee Started BY Approved BY Notes
BUILDING
PLUMBING
MECHANICAL
ELECTRICAL
OTHER
VI. ADDITIONAL PERMITS REQUIRED OR OTHER JURISDICTION APPROVALS
Permit or Approval Check Date Number B Permit or Approval Check Date Number B
PP Obtained Y pP Obtained Y
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 _U FOR DEPARTMENT USE ONLY
Permit number
Building r Use Group
Permit issued �1��� 19�
Building Fire Grading
Permit Fee $ ��,t Live Loading
Certificate of Occupancy $ Occupancy Load
Approved by:
Drain Tile
Plan Review Fee
TITLE --
NOTES and Data — (For department use)
� l
CITY OF NORTHAMPTON
OFFICE OF THE INSPECTOR OF BUILDINGS
212 MAIN STREET APPLICATION FOR
NORTHAMPTON, MA. 01060 PLAN EXAMINATION AND
L -
/ 71 BUILDING PERMIT
z
IMPORTANT — Applicant to complete all items in sections: 1, 11, 111, IV, and IX. O
"— 6./ ZONING
I AT (LOCATION) • " DISTRIC�
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 m
M
1 ❑ New building 9 Residential Nonresidential
2 ❑ Addition(If residential, enter number 12N 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
Alteration (See 2 above)
3 number of units- - - - -)- 20 ❑ Industrial
,�
14 ❑ Transient hotel, motel, 21 ❑ Parking garage
4 ❑ Repair, replacement or dormitory - Enter number
❑ o units ------- - -� 22 ❑ Service station, repair garage
5 Wrecking (1J multifamily residential, f
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 (relocation)
7 F-1 Foundation only 170 Other - Specify 25 ❑ Public utility
t 26 ❑ School, library, other educational
B. OWNERSHIP - tG!%' ITi:l�ltlrtt. 4L4N�C'C_ 27 ❑ Stores, mercantile
8:6< 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
�6 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 $ &0
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 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 .....................
33 ❑ Reinforced concrete H. TYPE OF WATER SUPPLY
34 ❑ Other - Specify 42 X 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 ❑ Gas Will there be central air 52. Outdoors........................
36 A Oil conditioning? L. RESIDENTIAL BUILDINGS ONLY
37 ❑ Electricity 44❑ Yes 45J<—] No 53. Number of bedrooms..............
38 ❑ Coal
39 ❑ Other - Specify Will there be an elevator? Full..........
54. Number of
46 ❑ Yes 471< No bathrooms
Partial.......
I hereby certify that the proposed work is authorized by tie owner of record
and I have been authorized by the owner to make this app!;ption as his
authorized agent.
SIGNATURE OF -AGENT _
ADDRESS
(NUMBER) (STREET) _ (CITY)
APPROVED BY TITLE
DATE 19
- DEPAR'i'ENT OF BUILDING INSPECTIONS z DEPT. FILE COPY
212 MAIN S
NORTONN, MBA. 01060 BUILDING �a
PERMITVALIDATION
17C - 174
DATE agntember 18, 19 79 PERMIT NO. 454
APPLICANT, CaLrl A„clran ADDRESS 22 Pstirflold Ave.
(NO.) (STREET) (CONTR'S LICENSE)
OF
PERMIT TO Wood stove ( 2 ) STORY Wood-burning furnace DWELLLRING UNITS 1
(TYPE OF IMPROVEMENT) NO. (PROPOSED USE) -
ZONING
AT (LOCATION)
22 Fairfield Avenue DISTRICT UB
(NO.) (STREET)
a BETWEEN AND
'D (CROSS STREET) (CROSS STREET)
a
LOT
d SUBDIVISION LOT BLOCK SIZE
m
4
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)
0:
0 REMARKS: HOMWynQd gtoVe �rnace) forced hat air ducted, existl= chi=ey
to be used in lieu of existing oil furnace.
AREA OR
VOLUME ESTIMATED COST $ 600.00 FEEMIT $ 10.00
(CUBIC/SQUARE FEET)
OWNER ( art & Ibrothv Arr9rcos
ADDRESS _
22 Fairfield Ave.. N'ton. Bvl 1N T
(Affidavit on reverse side of application to be completed by authorized agent of owner)