18C-048 (34) NOTES and Data — (For department use)
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APPLICATION FOR
- PLAN EXAMINATION AND
BUILDING PERMIT
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IMPORTANT — Applicant to complete all items in sections: 1, 11, 111, IV, and IX. C)
J ZONING
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I• AT (LOCATION) / 3*7 13 r f Ja e 8a-'^ DISTRICT.
LOCATION (NO.) (STREET) /�
OF BETWEEN H(J*,r jo I al 54 AND 13 I' /J p /C
BUILDING (CROSS STREET) (CROSS STREET)
LOT
SUBDIVISION LOT BLOCK SIZE
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II. TYPE AND COST OF BUILDING — All applicants complete Parts A — D ;0
A. TYPE OF IMPROVEMENT D. PROPOSED USE — For"Wrecking" most recent use M
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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 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 — 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 F—] Carport Office, bank, professional
6 ❑ Moving (relocation)
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,••,,••..••,,,•. b 0, 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.....................
In nj 4r sha A in ,o au at-ea
b. Plumbing .....................
c. Heating, air conditioning..........
d. Other (elevator, etc.).............
11. TOTAL COST OF IMPROVEMENT $
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
If Ay
30 Masonry (wall bearing) 40❑ 48. Number of stories................Public or private company r
31 Wood frame 41 ❑ Private (septic tank, etc.) 49. Total square Feet of floor area, ` 0-1f,0 �v3L0 t
all floors, based on exterior
32 ❑ Structural steel dimensions ....................
33 ❑ Reinforced concrete H. TYPE OF WATER SUPPLY
34 ❑ Other — Specify 4M 2 Public or private company 50. Total land area, sq. ft. ..........
43 ❑ Privoie (well, cistern) K. NUMBER OF OFF-STREET
PARKING SPACES
51. Enclosed .....................
F. PRINCIPAL TYPE OF HEATING FUEL I. TYPE OF MECHANICAL
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? 54. Number of Full..........
•. �
46 ❑ Yes 47 E� No bathrooms
Partial.......
VI11. ZONING PLAN EXAMINERS NOTES
DISTRICT
USE
FRONT YARD
SIDE YARD SIDE YARD
REAR YARD
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NOTES
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IX. SITE OR PLOT PLAN — For licant Use
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BOCA FORM APEBP — 669 C1969 BUILDING OFFICIALS & CODE ADMINISTRATORS INTERNATIONAL, INC.
IV. IDENTIFICATION — To be completed by all applicant. ,
Name Mailing address — Number, street, city, anri State ZIP code Tel. No.
I.
Owner or
Lessee
Builder's
L.
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
00 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
rova I Check Dare Number em Approval Check N
Date
Permit or A umber B
pp N b B Obtained y Permit or A 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 FOR DEPARTMENT USE ONLY
Permit number
Building Use Group
Permit issued 19 �
Fire Grading
Building /GC1 o
Permit Fee $ ` Live Loading
Occupancy Load
Certificate of Occupancy
Approved by:
Drain Tile
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Plan Review Fee
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PERMIT
(sic,,,, 4e VALIDATION 11 ''��JJDAT i Lo / P RMIT NO. �` 7
APPLICANT ADDRESS
(NO.) ( TREET) (CONT R'S LICENSE)
NUMBER OF
PERMIT TO (_) STORY DWELLING UNITS -
(TYPE OF IMPROVEMENT) NO. (PROPOSED USE)
ZONING
AT (LOCATION) DISTRICT
(NO.) 40 (STREET)
BETWEEN AND
(CROSS STREET) (CROSS STREET)
LOT
SUBDIVISION LOT BLOCK SIZE
BUILDING IS TO BE FT. WIDE BY FT. LONG BY FT. IN HEIGHT AND SHALL CONFORM IN CONSTRUCTION
TO TYPE ^ USE GROUP BASEMENT WALLS OR FOUNDATION
{� (TYPE)
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REMARKS:
PERMIT lo (k)
AREA OR ESTIMATED COST $ FEE C
VOLUME
(.WfE7C/S ARE FEET)
OWNER BUILDI T
BY
ADDRESS
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