11A-070 FORM NO. BOCA-BP 1969
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VIII. ZONING PLAN EXAMINERS NOTES
i
DISTRICT
USE
FRONT YARD
SIDE YARD SIDE YARD
REAR YARD
NOTES
IX. SITE OR PLOT PLAN — For Applicant Use
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NOTES and Data - (For department use)
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IV. IDENTIFICATION - To be completed by all applicants
Name Mailing address — Number, street, cit%, arul Slate ZIP code Tel. No.
Owner or InOA w 0,5 /N.� ? b c''r A/0 AJJ 6'i 44 A-1
Lessee Ike r JK ;f/ c_,S%Nu, S} /=Lc'/eiVc C-� /L A--5..>
i Builder's
2.
�/i' License No.
r 'C�
Contractor
Architect �✓
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
�� ✓ � C',. .. '' 1°J 77
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
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
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
Building
Permit issued £ Lv 1977
Building 4
Permit Fee
•
Certificate of Occupancy S -_
Ap ved by:
Drain Tile
.,e4ta
Plan Review Fee S— �"
1 TITLE
•4o..=,n,,ray
i,, t, e (Eif, of '�n t11ampton
*; 4 r'I Glnssr<clfusetfs
Qttat.. _� Office of the 3lns}lertot' of uilbings
-gam �1 APPLICATION FOR
Page �� Plot `�v ZONING PERMIT AND
BUILDING PERMIT
IMPORTANT - Applicant to complete all items in sections: 1, II, Ill, IV, and IX. Z
O
-{ ZONING r,(I�//��
I. AT (LOCATION) w' - °ht�' DISTRICT=�-�
LOCATION ('"O,) (STREET)
OF BETWEEN AND
BUILDING (CROSS STREET) (CROSS STREET)
LOT
SUBDIVISION LOT BLOCK SIZE
Cl)
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
-I
1 I I New building Residential Nonresidential
2 I Addition(If residential, enter number 12 One family 18 I Amusement, recreational
of new housing units added, if any,
in 13 Two or more family - Enter 19 I Church, other religious
in Part D, 13) number of units- - - - -3.
3 I Alteration (See 2 above) 20 I Industrial
4
14 I I Transient hotel, motel, 21 Parking garage
Repair, replacement or dormitory - Enter number
5 Wrecking (If multifamily residential, of units - 22 I Service station, repair garage
enter number of units in building in 15 I Garage 23 Hospital, institutional
Part D, 13)
16 I I Carport 24 Office, bank, professional
6I I Moving (relocation)
17 I I Other - Specify 25 I Public utility
7I I Foundation only
26 I School, library, other educational
B. OWNERSHIP 27 Stores, mercantile
8 K Private (individual, corporation, 28 I Tanks, towers
nonprofit institution, etc.) 29 I 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 $ t.9e>ODF 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 $ `)L,coo,
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. y
O
E. PRINCIPAL TYPE OF FRAME G. TYPE OF SEWAGE DISPOSAL J. DIMENSIONS m
48.
30 L_J Masonry (wall bearing) 40:1 ,1 Public or private company Number of stories
31 Wood frame 41 I I Private (septic tank, etc.) 49. Total square feet of floor area,
all floors, based on exterior
32 I I Structural steel dimensions
33 I I Reinforced concrete H. TYPE OF WATER SUPPLY
34 I I Other - Specify 42 Public or private company 50. Total land area, sq. ft.
43 I I Private(well, cistern) K. NUMBER OF OFF-STREET
PARKING SPACES
I-
F. PRINCIPAL TYPE OF HEATING FUEL I. TYPE OF MECHANICAL 51. Enclosed N/ 0
35 Gas Will there be central air 52. Outdoors JV ,)
36 Oil conditioning?
L. RESIDENTIAL BUILDINGS ONLY
37 I Electricity 44 I .1 Yes 45,1 No 53. Number of bedrooms .�
38 I I Coal
39 I I Other - Specify Will there be an elevator? Full
54. Number of
46 I 1 Yes 47 X No bathrooms Partial