17C-218 (4) VIII. ZONING PLAN EXAMINERS NOTES
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DISTRICT
USE
FRONT YARD
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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, street, city, and State ZIP code Tel. No.
Owner or 1"..'� ' , df. ,^ v f ✓ a .,� �
Lessee
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 applicant J / J Address Application date
D0 NOT WRITE BELOW THIS LINE
V. PLAN REVIEW RECORD — For office use
Plans Review Re uired 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 Date
Permit or Approval Check Obtained Number By Permit or Approval Check Obtt.ined 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 l Use Group
Permit issued / � 19 7 -7
Fire Grading
Building
Permit Fee �/� Live Loading
Certificate of Occupancy $ Occupancy Load
Approved by:
Drain Tile $
Plan Review Fee $
TITLE
4"
NOTES and Data — (For department use)
CITY OF NORTHAMPTON
OFFICE OF THE INSPECTOR OF BUILDINGS +l
212 MAIN STREET APPLICATION FOR
NORTHAMPTON, MA. 01060 PLAN EXAMINATION AND
BUILDING PERMIT
z
IMPORTANT — Applicant to complete all items in sections: 1, 11, 111, IV, and IX. 0
ZONING
(• AT (LOCATION) • ✓/ 1 /,}`/ ,/"— - ,,,� DISTRICT �
LOCATION (NO.) (STREET)
OF BETWEEN AND
BUILDING (CROSS STREET) (CROSS STREET)
LOT
SUBDIVISION LOT BLOCK SIZE
V1
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 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) 13XTwo or more family — Enter °� 19 ❑ Church, other religious
3 Alteration (See 2 above)
number of units— — — — � k -/ 20 ❑ Industrial
�
14 ❑ Transient hotel, motel, 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 ❑ Moving (relocation)
1 Other — SpeciJy 25 E] Public utility
7 ❑ Foundation only
26 ❑ School, library, other educational
B. OWNERSHIP 27
rG ? Stores, mercantile
❑
28 ❑ Tanks, towers
8,PN Private (individual, corporation, Specify
Other —
nonprofit institution, etc.) 29 ❑ P fy
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 Is CSC)
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. TY E OF SEWAGE DISPOSAL J. DIMENSIONS
30❑ Masonry (wall bearing) 40 Public or private company 48. Number of stories.,.f! ..
31 Wood frame 41 E] Private (septic tank, etc.) 49• Total square feet of floor are./,
all floors, based on exterior
32 Structural steel dimensions .....................
33 ❑ Reinforced concrete H. kYPE OF WATER SUPPLY
34 F-1 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 Gas Will there be central air 52. Outdoors........................
36 Oil conditioning?
L. RESIDENTIAL BUILDINGS ONLY
37 Electricity 44❑ Yes 45� No 53. Number of bedrooms..............
38� Coal
39 ❑ Other — Specify Will there be an elevator? Full..........
54. Number of
46 ❑ Yes 47 qNo bathrooms
Partial.......
.I 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 this
authorized agent.
SIGNATURE OF AGENT
ADDRESS
(NUMBER) (STREET) (CITY)
APPROVED BY TITLE
DATE 19
DEPT. FILE COPY
ZQ
DWARTNE NT OF BIIILDING INSPECTIONS 'O a
X212 STREET BUILDING as
NORTHrA,P9PT N. M@• 41060 17C-218 PERMIT VALIDATION
Denis J. Walsh DATE March 5t 19 79 PERMIT NO. CQa
APPLICANT 99MVER ADDRESS �3g Hri4 Rd• , F10•
(N0.) (STREET) (CONTR'S LICENSE)
PERMIT TO Alter residence STORY Residence NUMBER OF
DWELLING UNITS
(TYPE OF IMPROVEMENT) NO. (PROPOSED USE)
ZONING
AT (LOCATION) 2� NA. MRz Ze St. } �� DISTRICT CB
(N0.) (STREET)
a BETWEEN AND
a
(CROSS STREET) . (CROSS STREET)
D' LOT
m SUBDIVISION LOT BLOCK SIZE
a
V
M BUILDING IS TO BE FT. WIDE BY FT. LONG BY FT. IN HEIGHT AND SHALL.CONFORM IN CONSTRUCTION
O
Z TO TYPE USE GROUP BASEMENT WALLS OR FOUNDATION
f
� (TYPE)
OL, REMARKS: ._. New Atai,rFa $ donra
AREA OR s
VOLUME ESTIMATED COST $ 500.00 FEEMIT 10.00
(CUBIC/SQUARE FEET)
OWNER Wdwardd P_ �»i gi- Q�0 M 11 an Walsh sh (GUardian) BUtLDI D 411�44
ADDRESS Bridge Rd., Flo, BY
(Affidavit on reverse side of application to be completed by authorized agent of owner)