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License No. Contractor y 3. Architect or Engineer I hereby certify that the proposed work is authorized by the owner of record and that 1 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 4-?pplicant 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 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 Building Permit issued 19 � Building Permit Fee $ /4' -------- Certificate of Occupancy S Approved by: Drain Tile $ Plan Review Fee S- ITL Ca,xt of Nort4allvvtou $ Aassactinsetts �u t Office of the �nsveCtor of 'ouilbings APPLICATION FOR T - ZONING PERMIT AND Page ` Plot_ BUILDING PERMIT z IMPORTANT — Applicant to complete all items in sections: I, 11, 111, IV, and IX. O ZONING +, I. AT (LOCATION) `' r ,''�'• DISTRICT ., LOCATION (NO') (STREET) OF BETWEEN AND BUILDING (CROSS STREET) (CROSS STREET) LOT SUBDIVISION LOT BLOCK SIZE I CIO 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 Resid fial Nonresidential 2 Addition(If residential, enter number 12 One family 18 ❑ Amusement, recreational of new housing units added, if any, 13❑ Two or more family — Enter 19 Church, other religious in Part D, 13) number of urzits— — — — --)� 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❑ Carport 24 Office, bank, professional 6 Moving elocation g ( ) 17 F__j Other — SpeciJy 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 (Z ✓/I 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 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 $ g ` 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. �— !7 E. PRINCIPAL TYPE OF FRAME G. TYPE OF SEWAGE DISPOSAL J. DIMENSIONS M 48. Number of stories............... 30❑ Masonry (wall bearing) 40 E Public or private company 49. Total square feet of floor area, 31 Wood frame 41 Private (septic tank, etc.) all floors, based on exterior 32 Structural steel dimensions .................... 33❑ Reinforced concrete H. TYPE F WATER SUPPLY 50. Total land area, sq. ft. ........... 34 F-1 Other — Specify 42 Public or private company 43 ❑ Private (well, cistern) K. NUMBER OF OFF-STREET PARKING SPACES .D 51. Enclosed ....................... O F. PRINCIPAL TYPE OF HEATING FUEL I. TYPE OF MECHANICAL 0 35 Gas Will there be central air 52. Outdoors........................ 36 Oil conditioning? L. RESIDENTIAL BUILDINGS ONLY 37 Electricity 44 ❑ Yes 45 1- No 53. Number of bedrooms.............. 1 38 Coal 39 Other — Specify Will there be an elevator? Full.......... 54. Number of bathrooms 46 Yes 47 dNa Partial........ 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 Zq DEPT.FILE COPY CITY OF HoRTrrax BUILDING III. PERMIT VALIDATION NoRnu M)m MM. 35-86 DATE September 15, 19 77 _ PERMIT NO. 4 APPLICANT Paul K. Ti mall ADDRESS Box 216 M 12a.6tham:UW (NO.) (STREET) (CONTR'S LICENSE) itinn (I_) STORY ftlaxm _ NUMBER OF PERMIT TO ��.�aati�n �,'!`ea, —DWELLING UNITS. (TYPE OF IMPROVEMENT) NO. (PROPOSED USE) r� ZONING 70 AT (LOCATION) Westwood Termee DISTRICT (NO.) (STREET) a BETWEEN AND b (CROSS STREET) (CROSS STREET) A LOT IL SUBDIVISION LOT BLOCK SIZE m ¢ Y 0 BUILDING IS TO BE 34FT. WIDE BY, 3 FT. LONG BY FT, IN HEIGHT AND SHALL CONFORM IN CONSTRUCTION O m O Z TO TYPE USE GROUP BASEMENT WALLS OR FOUNDATION I (TYPE) O: LL REMARKS: Rnla ," 'hnth myrnaya of rnom to width of existing house a.& above AREA OR VOLUME ESTIMATED COST .$_�n0Q FEEMIT $ 1,5.00 (CUBIC/SQUARE FEET) OWNER Je=ma Rsaw1owski BUILDING D PT ADDRESS_ 6 YiestHL od T93=1&•Ce,—Fl.fim- here BY :5 (Affidavit on reverse side of application to be completed by authors agent of owner)