31B-167 DEPT. FILE COPY
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NORTHAMPTON, MA. 01060 PERMIT
VALIDATION
31B - 167 CODE #74
DATE May 2A 19 _80 PERMIT NO. 276
APPLICANT R4cb-rd _T- Sbea ADORES 137 Rim
(NO.) (STREET) (CONTR'S LICENSE)
NUMBER OF
PERMIT TO {�_) STORY DWELLING UNITS 3
TYPE IMPROVEMENT) N0. PROPOSED SE
ZONING
AT (LOCATION) DISTRICURA
(NO.) (STREET)
rnBETWEEN AND +-re$Cent
w {CRO S STREET) . (CROSS STREET)
ca
LOT
0 SUBDIVISION LOT BLOCK SIZE
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4
0 BUILDING IS TO BE 24 FT. WIDE BY 30 FT. LONG BY FT. IN HEIGHT AND SHALL CONFORM IN CONSTRUCTION
m
O
Z TO TYPE USE GROUP BASENT WALLS OR FOUNDATION
"E (TYPE)
K
O
LL REMARKS: RA .t.
AREA OR $
VOLUME ESTIMA ED COST . FEEMIT 10. 0
(CUBIC/SQUARE FEET)
I
OWNER
Bu
ADDRESS BY , - e�-4�el
(Affidavit on reverse side of application tobe ompleted by authorized agent of owner)
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 his
authorized agent.
SIGNATURE OF AGENT
ADDRESS
(NUMBER) (STREET) (CITY)
APPROVED BY TITLE
'DATE 19
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CITY OF NORTHAMPTON
OFFICE OF THE INSPECTOR OF BUILDINGS
212 MAIN STREET APPLICATION FOR
NORTHAMPTON, MA. 01060 PLAN EXAMINATION AND
/3 BUILDING PERMIT
IMPORTANT — Applicant to complete all items in sections: 1, 11, 111, IV, and IX. O
I• ZONING
AT (LOCATION) It� % l < 1!� �L DISTRICT
LOCATION IN 0.) (STREET) ��1c
OF BETWEEN �L -g— _ � A N D L�-r.Y�_..r-rr i!G-L'L. .=�L'/.�•
BUILDING (CROS STREET) (CROSS STREET)
LOT
SUBDIVISION LOT BLOCK SIZE
CA
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 D<JAddition(If residential, enter number 12 ❑ One family 18 ❑ Amusement, recreational
of new housing units added, if any,
in Part D, 13) 13 Wwo or more farnily — Enter 19 ❑ Church, other religious
number of units— — — — -- 20 ❑ Industrial
3 Alteration (See 2 above) 14 ❑ Transient hotel, motel,
21 ❑ Parking garage
4 ❑ Repair, replacement or dormitory —i Enter number
5 ❑ Wrecking (IJ multifamily residential, of units --+---- — — 22 Service station, repair garage
enter number of units in building in 15 Garage Qet/x 34 23 ❑ Hospital, institutional
Part D, 13)
16 Elp Carport 24 ❑ Office, bank, professional
6 ❑ Moving (relocation)
17 ❑ Other — Spec#fy 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
OZ �l processing plant, machine shop, laundry building at hospital, elementary
10. Cost of improvement,,,,•,•••••••••• V school, secondary school, college, parochial school, parking garage for,
departmerpt 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 — 7
a. Electrical..................... UL,
b. Plumbing .....................
c. Heating, air conditioning..........
d. Other (elevator, etc.).............
11. TOTAL COST OF IMPROVEMENT $ G1
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
Number of stories....
30[_J�Masonry (wall bearing) 40� 49. Total square feet of floor area,
Public or private company48. """""'
31 Wood frame 41 Private (septic tank„etc.) all floors, based on exterior
32 Structural steel dimensions .....................
33 ❑ Reinforced concrete H. TYPE OF WATER SUPPLY
34 ❑ Other — Specify 42fXLPublic 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 MECHANICAL51. 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?
F
54. Number of ull.........
46 ❑ Yes 47 Fl,;4 No bathrooms partial........
I
NOTES and Data — (For department use)
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ZZ
IV. IDENTIFICATION — To be completed by all applicants
Name Mailing oddr s Number, street, city, and State ZIP code Tel. No.
Owner or
Lessee
Builder's
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
Plans Review Required Check Plan Review Date Plans By Date Plans By Notes
Fee Started Approved
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 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 Use Group
Permit issued 19
Building Fire Grading
Permit Fee '/0' tcJ
Live Loading
Certificate of Occupancy $ Occupancy Load
A ved by:
Drain Tile $
Plan Review Fee $
TITLE
JI/ 3
VI11. ZONING PLAN EXAMINERS NOTES
DISTRICT
USE l r
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 B CODE ADMINISTRATORS INTERNATIONAL, INC.