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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 Applicattiion 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 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 1�aJ Building Permit issued � � �' �� 19 Building Permit Fee $ Certificate of Occupancy APPhY�d bY: Drain Tile Plan Review Fee TITLE O� O Cr ztg of Xort4amptnn � � �Glass�cl1ixsctts Offzte of the �Insipertor of 'Puilaings APPLICATION FOR ZONING PERMIT AND 3 , Page Plot /.3 BUILDING PERMIT IMPORTANT — Applicant to complete all items in sections: 1, 11, 111, IV, and IX. 0 y f j� ,c� ^ ZONING (�JZ I• AT (LOCATION) /10�f uyeo ) +�� F�OleC n` e, DISTRICT' LOCATION (NO.) (STREET) OF BETWEEN AND BUILDING (CROSS STREET) (CROSS STREET) LOT SUBDIVISION LOT BLOCK SIZE 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 IT! 1 ❑ New building Resid tial Nonresidential 2 ❑ Addition(If residential, enter number 12 TOne 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– – – – –I. 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 enter number of units in building in 15 ❑ Garage 23 ❑ Hospital, institutional Part D, 13) 24❑ Office, bank, professional 6 ❑ Moving (relocation) 16 ❑ Carport 17❑ Other – Specify 25❑ Public utility 7 ❑ Foundation only � j 26 ❑ School, library, other educational B. OWN RSHI P 0— , �e� /OM 27 ❑ Stores, mercantile 8 Private (individual, corporation, p 28 ❑ Tanks, towers nonprofit institution, etc.) l I P_ 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 �o© 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 $ 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 IT! 30❑ Masonry (wall bearing) 40 ❑ Public or private company 48• Number of stories............... 31 ❑ Wood frame 41 ❑ 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 42 Public or private company 50. Total land area, sq. ft. ........... 34 ❑ Other — Specify ❑ p 43 ❑ Private (well, cistern) K. NUMBER OF OFF-STREET PARKING SPACES 51. Enclosed ....................... r 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 ❑ No 53. Number of bedrooms.............. 38 ❑ Coal 39 ❑ Other – Specify Will there be an elevator? 54. Number of Full.......... 46 ❑ Yes 47 ❑ No bathrooms 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. P— e SIGNATURE 0P `AGENT ADDRESS (NUMBER) (STREET) (CITY) APPROVED BY TITLE DATE 19 F- DEPT. PILE COPY Z BUILDING CITY OF NORTHANMN PERMIT g. VALIDATION NORTHAMM r, Mai. 01060 36-139 DATE April 18, 19 7� PERMIIT71 NO 105 APPLICANT TanjeA R. .Shah sm ADDRESS {ND �V1(sa ETt Flo• (CONY R'S LICENSE) NUMBER OF PERMIT TO TnigtalI Chimney (_) STORY Chimney DWELLING UNITS 1 (TYPE OF IMPROVEMENT) NO. (PROPOSED USE) ZONING AT (LOCATION) 36 Longview Drive, Florence$, Ma. DISTRICT (NO.) (STREET) w BETWEEN AND 'o (CROSS STREET) (CROSS STREET) a LOT a SUBDIVISION LOT BLOCK SIZE m a U O BUILDING IS TO BE FT. WIDE BY FT. LONG BY FT. IN HEIGHT AND SHALL CONFORM IN CONSTRUCTION m O Z TO TYPE USE GROUP BASEMENT WALLS OR FOUNDATION (TYPE) O: LL REMARKS: Install cinderbihoek chimney AREA OR VOLUME ESTIMATED COST .$ 7EF)RMIT $ 1©.00 (CUBIC/SQUARE FEET) OWNER Raid d & Janine Sharman ADDRESS 36 UnUryiew MUM, Florence, M&. _, BY (Affidavit on reverse side of application to be completed by authorized agent of owner)