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REAR t
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OFFICE of the INSPECTOR of BUILDINGS 140) -�- ke-, 6?,4-rff 5
Page r'. Plot — APPLICATION FOR
INSPECTOR ZONING PERMIT AND
BUILDING PERMIT
IMPORTANT — Applicant to complete all items in sections: 1, 11, 111, IV, and IX. O
//jj j
ZONING
I• AT (LOCW1TN) I y�7/`pE� DISTRICT
LOCATION IND.) C ISTyREEEE7) '
OF BETWEEN li lei 1E ) U ( r `'V4 i ukl,, ! AND �.
BUILDING (CROSS STREET) (CROSS STREET)
LOT
SUBDIVISION IV a LOT BLOCK .� SIZE
N
II. TYPE AND COST OF BUILDING — All applicants complete Parts A — D
A. TYPE OF IMPROVEMENT D. PR SED USE — For"Wrecking" most recent use m
M
1 ❑ New building Residential Nonresidential lid
2 0 Addition(If residential, enter number 12 ❑ One family 18 ❑ Amusement, recreational
fW4k-rte of new bousing units added, if any,
1
in Past D, 13) 13 wro or more family — Enter 19 ❑ Church, other religious
3 [& Alteration (See 2 above)
t r "les t' number of units— — — — � 20 ❑ Industrial
v 14 Transient hotel, motel,
4 Repair, re (acemeni _a� � ❑ 21 �� Parking garage
P P � � — � b/ or dormitory — Enter number
���� f1�rT l o units ------- — i 22 ❑ Service station, repair garage
5 ❑ Wrecking (l/multijkmily residential, f
enter number of units in building in 15 ❑ Garage 23 ❑ Hospital, institutional
Part D, 13) 16 ❑ Carport 24 Office, bank, professional
6 ❑ Moving (relocation)
7 ❑ Foundation only 17❑ Other — Specify 25 ❑ Public utility
<ralq( L t ) 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,,•,,•,,,,,,,••, 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 bu' ing is being changed, enter proposed use.
in the above cost
a. Electrical..............� .E.'.....
b. Plumbing ..............�((t.f.'....
c. Heating, air conditioning..11.l..... l
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 5QIN f'.CL1m
48. Number of stories................
30❑ Masonry (wall bearing) 40 Public or private company
31 Wood frame 41 ❑ Private (septic tank, etc.) 49. Total square feet of floor area,
all floors, based on exterior f
32 ❑ Structural steel dimensions ..................... i
33 ❑ Reinforced concrete H. TYPE OF WATER SUPPLY
34 ❑ Other — Specify 42 C-S 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 .......................
ii � kk'' ,
35� Gas Will there be central air 52. Outdoors...C ' V..f/Y..I. ~
36 ❑ Oil conditioning? � L'u_)lco
37 E_j Electricity 44 ❑ Yes 45 No L. RESIDENTIAL BUILDINGS ONLY
53, Number�off,bedrooms......... ..
�0 ft 39 [7 0 h 54. Numer — Specify Will there be an elevator" um f � )
Full..........
46 _ ber of
1 Yes 47y( No bothrooms
'''"' Partial........
�EXs S i/U - TL>J1 0 Ic,Al t -1 &.1 01 TiCa�-r N c, X60 v Q r-fS ,4��c D
IV. IDENTIFICATION — To be completed by all applicants^
Name Mailing address — Number, street, city, and State ZIP
(`code Tel. No.
Owner Or L - Y�C.Cm\i 3_ � l i Lf.-'ISMS ST C i � L�f 016 (1
Lessee C' / V
2. Di)UC- C.�.fj'�.1� �� CSC— !�1'`V � I�T License r,No.
Contractor
Y3y
3.
Architect or
Engineer
I hereby cer t that the pro waTk-�s authorized by the owner of record and that I have been authorized by the owner to
make this ap lidation a author_ agent and we agree to conform to all applicable laws of this jurisdiction.
Signature of ap li a t Address ��c��� Application date
00 NOT WRITE BELOW THIS LINE
V. PLAN REVIEW RECORD — For office use
Plans Review Required Check Plan Review Date Plans B Date Plans B Notes
4 Fee Started y Approved y
BUILDING $
PLUMBING $
MECHANICAL $
ELECTRICAL $
OTHER $
VI. ADDITIONAL PERMITS REQUIRED OR OTHER JURISDICTION APPROVALS
Permit or Approval Check ObDatned Number By Permit or Approval Check o Date
ed 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 Lt �^ FOR DEPARTMENT USE ONLY
Permit number
Building ., j _(�O Use Group
Permit issued ! 6 19
Building !� /� Fire Grading
Permit Fee $ Lire Loading
Certificate of Occupancy $ Occupancy Load
A
Drain Tile $ pprove by:
Plan Review Fee $
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