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A NOTES and Data — (For department use)
ZONING PERMIT
'
APPLICATION
'Zoning Crdiom/xe S'otinn 10.:�. File 1,10. PL-in rile
Address
Telophonc
This section is to be fiIIoJ out in occordcuoo riih Ule »f Dim�uaioorI and
District A r cn ',',Ii d U I Yr o I I t "Side Space
Prece Proposed
ilxrk tbe apprbyrint* )'oz to iodic,)te tbe usr of +b' rz)ropI:
F--� 0011-CoufnrmiuC Iot ^ud/or �truoture. 3l`eoify�_______'--_--'-____'__-
Beai8cutiol ~�) Y��lSiuCle Fm`i]y Voit. F--lVniti-yomiIJ
F---lDuDlez F--l0tbai
Buoiuena
�=~�
\ |
Industrial
----
Ioatitutinp~]
�--1
Subdivision [--lRe"u] �r P.U.D.
oiher
| ) Subd1vioi'`u pith n�['�rov'O,�ot-�r7nirr�i"-3tnm��
[--lPIuuuing �onrd Ap|/znvrl,
F-� ZnoiuJ Board Approval (SDeoinI Permit l0.�: V,rinnom)
= City Council (8 i l Fx t± )
Natershed Protection District Overlty: (Z.O. Sect. ..'IV)
Loading Space Requirement;c: (Z.O. cect. 8.2) Require Proposed
Plot Plan Yes 1,10 Si te Plan Yes 0
Thin t1ou for 0��ICI�� o�o onlJ:
-Approval oo preoeutcd:
=Modifications, ucnoonory for z,Dyrnvnl:
�--]Beturo; (0orw iofurmntinu u(--pded)
�-� DeuinI: Bennooa:
-
_
Si n ture of ApPlicant Dntp |
(11nillo 1)fficcr Do Le
------- ----| -----
/
IV. IDENTIFICATION — To be completed by all applicants
Name Mailing address — A'cumber, sfree(, ctfN, and �ta(e ZIP code Tel. No.
Owner or 41/f'
Lessee
i l C'rl C_% "�•
Eiullder's
L.
License No.
Contractor
3.
Architect or
Engineer
S �=
1 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
Wiz, . '�i l �' a VL i r��/'•7�/° 44"4! L�
D0 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
Permit or A rova I Check Date Number B Permit or A rova I Check Dare Number 8
pp Obtained y 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
Permit number
Building
Permit issued 19 z
Building r `16
Permit Fee $
Certificate of Occupancy $
Approved
Drain Tile 'f
Plan Review Fee S—
TITLE
0� ro �
,� �� �[xss�clfusetts
T Office of the Insptrtor of 'Puilbings
APPLICATION FOR
Page ' '') Plot ZONING PERMIT AND
BUILDING PERMIT
IMPORTANT — Applicant to complete all items in sections: 1, 11, 111, IV, and IX. p
ZONING
AT (LOCATION) 7-.. -' ✓i ``I-s �� '. 1-I� DISTRICT
LOCATION (NO.) (STREET)
OF BETWEEN AND
BUILDING (CROSS STREET) (CROSS STREET)
LOT
SUBDIVISION LOT BLOCK SIZE
y
II. TYPE AND COST OF BUILDING — All applicants complete Parts A — D m
A. TYPE OF IMPROVEMENT D. PROPOSED USE — For"Wrecking" most recent use m
1 ❑ New building Residential Nonresidential
21RI Addition(If residential, enter number 12 S 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 ——————— — -i 22 Service station, repair garage
ea
enter number of units in building in 15 ❑ Garage 23 ❑ Hospital, institutional
Part D, 13)
16 ❑ Carport 24❑ Office, bank, professional
6 ❑ Moving (relocation)
17❑ Other — SpeciJy 25 E] Public utility
7 ❑ Foundation only yy
26 El School, library, other educational
B. OWNERSHIP 27 Stores, mercantile "
28 ❑ anks,'towers
8 Private (individual, corporation,
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,,,,,,,,,,,,,,,, f 'i-" '1' 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 $
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. D
0
E. PRINCIPAL TYPE OF FRAME G. TYPE OF SEWAGE DISPOSAL J. DIMENSIONS M
30❑ Masonry (wall bearing) 40 ❑ Public or private company Number of stories...............
3 Wood frame 4f,�Z Private (septic tank, etc.) 49. Total square feet of floor area,
all floors, based on exterior
32 Structural steel dimensions .....................
33❑ Reinforced concrete H. TYPE OF WATER SUPPLY
34❑ Other — Specify 42 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 ....................... O
35❑ Gas Will there be central air 52. Outdoors........................
36 Oil conditioning? L. RESIDENTIAL BUILDINGS ONLY
37❑ Electricity 44❑ Yes 45 3 No 53. Number of bedrooms.............. J
38 ❑ Coal
39 Other — Specify Will there be on elevator? 54. Number of Full..........
46 ❑ Yes 47 2 No bathrooms
Partial........
I 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
DEPT. FILE COPY
Z
BUILDING
PERMIT
VALIDATION
ATE 19 / PERMIT NO.
Aj
APPLICANT ADDRESS
IN 07 (STREET) (CONT R'S LICENSE)
( ) NUMBER OF
STORY
PERMIT TO �� �'+�� DWELLING UNITS
(fYPE OF IMPROVEMENT) 0. (PROPOSED USE)
ZONING
AT (LOCATION) DISTRICT
NO.) (STREE )
a BETWEEN AND
�p (CROSS STREET) (CROSS STREET)
a
- LOT
IL SUBDIVISION LOT BLOCK SIZE
m
O BUILDING IS TO BE FT. WIDE BY FT. LONG BY FT. IN HEIGHT AND SHALL CONFORM IN CONSTRUCTION
O
m
O USE GROUP BASEMENT WALLS OR FOUNDATION
Z TO TYPE (TYPE)
LL REMARKS:
PERMIT
AREA OR
VOLUME ESTIMATED COST $ FEE
(CUBIC/SQUARE FEET)
0
OWNER BUILDING EPT
ADDRESS BY
(Affidavit on reverse side of application to be completed by author( agent of owner)
i
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