23A-277 (6) �G DEPT. FILE COPY
z `�` ` °'� BUILDING 04
J PERMIT
VA LiDn TION
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APDL KANT���}�'�"'� —"�� ADDRESS G `f�
(NO.} (STRUT) ICOWTR`S LICENSE)
PERMIT TO i__.Y STORY DWELLRINGOFUNITS
(TYPE Or IMPROVEMENT) X OIME)
E)
� PyIZONI
AT {LOCATION) h DIST
Y .... R
1X0.1 / (STREET) DISTRICT
S
BETWEEN ANO
(CROSS EMIT: ICROU STREET)
O LOT
M- sugoiVS ION_ LOT BLOCK S12E
0
O BUILDING IS TO SE FT. WIDE BY FT. LONG OY FT. IN HEIGHT AND SHALL CONFORM IN CONSTRUCTION
a
Z TO TYPE USE GROUP BASEMENT WALLS OR FOUNDATION
S �E'�J���- . (TYPE)
er
N o
• REMARKS: 'L•6 I // /
AREA OR $ 301:{*CMS.)CMPERo
p
MIT ,00
VOLUME ESTIMATED COST N FEE ��PPii
IcU Ic/SOUAfiE FEET) /��,�/'//�J'J/
OWNER h�.�} YFF,tlJ4�j �(j<•yL BUILD++0G��'�'
ADDRESS °1011444,4.40.-{ -_••J BY
(Affidavit on reverse side of application to be completed by authorized agent of owner)
i 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_..
^ . I (City of 3iTortliauipton
'p�14 " + '
jRxsaxg¢nsetts
mur"r_.,.a"
4a�. ;y (®ffice of the �lnspertor of AuiIbings APPLICATION FOR
Page ,23 A Plot a2 ) 7 ZONING PERMIT AND
BUILDING PERMIT
IMPORTANT - Applicant to complete all items in sections: I, II, III, IV, and IX. p
�h ISTRIC
AT (LOCATION) ONING
Z
LOCATION Lo.) `STREET,
OF BETWEEN AND
BUILDING (CROSS irF[[T, (CROSS STREET)
LOT
SUBDIVISION LOT BLOCK SIZE
N
II. TYPE AND COST OF BUILDING - All applicants complete Parts A - D XI
A. TYPE OF IMPROVEMENT D. PROPOSED USE — For"Wrecking" most recent use In
1 gj New building Residential Nonresidential
2I I Additien(If residential, enter number 12X One family 18 El Amusement, recreational
of new housing units added, if any.
Part0
in U, ]3) 13 1 I Two or more family — Enter 19 I Church, other religious
number o/ units— — — — —tr• 201 I Industrial
3 in Alteration (See 2 above)
14 ri Transient hotel, motel, 21 Hi Parking garage
• 41 I Repair, replacement or dormitory — Enter number
5 X Wrecking (If multi/amity residential, of units —y 22 Li Service station! repair garage
enter umber o/ units in building in is I ) Garage 23 7 Hospital, institutional
Part O, ]3) 161 I Carport 24 L] Office, bank, professional
6 EI Moving (relocation)
17 1 I Other — Specify 251 I Public utility
7 I I Foundation only
26 I I School, library, other educational
B. OWNERSHIP 271 I Stores, mercantile
B I;/Private (individual, orpor n, 281 Tanks, towers
nonprofit institution, etc.)otre29(-1 Other Specify
9 I I 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 $ 30C school, secondary school, college, parochial school, parking garage for,
deportment 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.
inthe abovecost �9
e.. Electrical
D��✓edi(L�s, laid
b. Plumb- 9 Owrw Y 7 067(-42,,
/"�
r n/O .- t4
c.Heating, air conditioning 2 ✓
d. Other (elevator, etc.)
/JJlspit .(x39.Ct.,a
11. TOTAL COST OF IMPROVEMENT $ 300
III. SELECTED CHARACTERISTICS OF BUILDING - For new buildings and additions, complete Parts E - L;
for wrecking, complete only Part.1, for all others skip to IV. D
L)
E. PRINCIPAL TYPE OF FRAME G. TYPE OF SEWAGE DISPOSAL J. DIMENSIONS in
30 f`Masonry (wall bearing) 40 r1 Public or private company 46. Number of stories
31 Wood frame 41 Private (septictank, etc.) 49. Total square feet of floor area,
Call floors, based on exterior
32 Li Structural steel dimensions
33 ii Reinforced concrete H. TYPE OF WATER SUPPLY
341 I Other — Specify 42 I I Public or private company W. Total land area, sq. ft
43 ❑ Private(well, cistern) K. NUMBER OF OFF-STREET
PARKING SPACES
-o
51. Enclosed I—
F.
F. PRINCIPAL TYPE OF HEATING FUEL I. TYPE OF MECHANICAL 0
351 I Gas Will there be central air 52. Outdoors
361 I 0❑ conditioning? L. RESIDENTIAL BUILDINGS ONLY
37 I I Electricity 44I I Yes 451 I No 53. Number of bedrooms
38 I—I Coal
39 fl Other — SPecify Will there be an elevator' { Full
54. Number of
46 I Yes 47 I I No bathrooms
Partial
IV. IDENTIFICATION – To be completed by all applicants
NameMoiling address — A . .vtrr. Rn
it , r ZIP code Tel. No.
re
Owns o, h/—K ��✓A (," ([ / 7t,-..c.„..........4....
Lessee
dl
Y. .(/ -L...4 24e✓_4.&. it L tilde No.
Contractor
r7� -.
3.
Architect o, .
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.
Siggjjnn//,eeta//of applicant ) Address Application date
DO NOT WRITE BELOW THIS LINE
V. PLAN REVIEW RECORD – For office use
Plops Review Required Check Plan Review Date Plans Date Plans B Notes
Fee Started By Approved y
BUILDING $ •
PLUMBING $
MECHANICAL S
ELECTRICAL $
OTHER S
VI. ADDITIONAL PERMITS REQUIRED OR OTHER JURISDICTION APPROVALS
Date ate
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
Permit number 41 f
Building �j
Permit issued Z� 197
Building `0 Uv
Permit Fee $ —
Certificate of Occupancy S —
A.. over by: 'Th9
Dram Tile S_ __ l
Plan Review Fee $— , , j� ea5
NOTES and Data — (For deportment use)
c
' ;'�.✓YF., ur.
n
VIII. ZONING PLAN EXAMINERS NOTES
DISTRICT l-G.
2-13
USE /�41 {ji,
FRONT YARD C
U / •
SIDE YARD �`/--r% SIDE YARD / 'o'
REAR YARD ! --Ci
NOTES
IX. SITE OR PLOT PLAN - For Applicant Use
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