36-160 (2) ZONING •
FRONT DISTRICT
• .
SIDE YARD SIDE YARD
REAR YARD
NOTES
IX. SITE OR PLOT
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NOTES and Data — (For department use)
IV. IDENTIFICATION — To be completed by all applicants
Name Mailing address — Number, strccf, (-rtN, and SIah, ZIP code Tel. No.
Owner or lc'
Lessee
BSI Ider's
C1 "1 1`` ��aC- / ,� 1 �. lam- ✓. L...� .l�t� 1..,�a.L� ��ls License No.
Contractor
3.
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
Y-
1 1 \ I ., ,�k 'i
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
9 Fee Started y Approved y
BUILDING $
PLUMBING
MECHANICAL
ELECTRICAL
OTHER
VI. ADDITIONAL PERMITS REQUIRED OR OTHER JURISDICTION APPROVALS
ate Date
Permit or Approval Check ObDtai ed 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
Building J ai
Permit issued _ 19 7
Building
Permit Fee $
Certificate of Occupancy
Approved by:
Drain Tile
Plan Review Fee _
�= TITLE
a Crxty of Nart4aUip#on
� � �Ixss�chiisetfs
Office of the 31nspertor of `Puilbings APPLICATION FOR
ZONING PERMIT AND
Page Plot BUILDING PERMIT
IMPORTANT — Applicant to complete all items in sections: 1, 11, III, IV, and IX. p
ZONING
I. AT (LOCATION) /! L ✓� "L ., -4 fJ 1 �e y�� '/ D STR CT��; _
LOCATION — '(NO.) (STREET) /
OF BETWEEN AND
BUILDING (CROSS STREET) (CROSS STREET)
LOT
SUBDIVISION LOT BLOCK SIZE ICA
II. TYPE AND COST OF BUILDING — A11 applicants complete Parts A — D m
A. TYPE OF IMPROVEMENT D. PROPOSED USE – For"Wrecking" most recent use m
1 ❑ New building Residential Nonresidential
2 ❑ Addition(If residential, enter number 12,t5Z] 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
3gAlteration (See 2 above) 14 Transient hotel, motel,
21 ❑ Parking garage
4 ❑ Repair, replacement or dormitory – Enter number
5 F__1 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 F-1 Carport 24 Office, bank, professional
6 ❑ Moving (relocation) ❑ Public utility
17� 25 u ity
Other – Specify
7 ❑ Foundation only 26 ❑ School, library, other educational r
B. OWNERSHIP 42,! 27 ❑ Stores, mercantile L
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,,,,,,,,••••...
/ fi school, secondary school, college, parochial school, parking garage for,
deportment 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 Is
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
0
E. PRINCIPAL TYPE OF FRAME G. TYPE OF SEWAGE DISPOSAL J. DIMENSIONS M
48. Number of stories...............
30 El 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 �U
32❑ Structural steel dimensions ..................... ?�
33❑ Reinforced concrete H. TYPE OF WATER SUPPLY
Public or private com an 50. Total land area, sq. ft. ...........
42
34❑ Other – Specify ❑ p p y
43 ❑ Private (well, cistern) K. NUMBER OF OFF-STREET
PARKING SPACES
51. Enclosed ....................... r
F. PRINCIPAL TYPE OF HEATING FUEL I. TYPE OF MECHANICAL O
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........
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i
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
f�,.y�I/'e�/,f�_� + DATE 19 PERM 0., 07
APPLICANIT-,` """"^w.4 ADDRESS���L (STREET) 'F
(ND.) (S7REET) (CONTR'S LICENSE)
�
` .fid.,' NUMBER OF
PERMIT TO '�A (`) STORY DWELLING UNITS a
(TYPE OF IMPROVEMENT) NO. (PROPOSED USE)
/ ZONING
� ZONING
AT (LOCATION) 4J + DISTRICT
(NO.) (STREET)
a BETWEEN AND
a
(CROSS STREET) (CROSS STREET)
LOT
n SUBDIVISION LOT BLOCK SIZE
m
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
I (TYPE)
it
O
IL REMARKS:
AREA OR 3� _ PERMIT
VOLUME ESTIMATED COST $ FEE
(CUBIC/ UARE FEET) ,.
t
OWNER
B
ADDRESS B
(Affidavit on reverse side of application to be completed by authorize agent of owner)