25A-110 (7) Vill. ZONING PLAN EXAMINERS NOTES
DISTRICT
L USE
FRONT YARD
SIDE YARD SIDE YARD
REAR YARD
IX. SITE OR PLOT PLAN For Applicant Use
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NOTES and Data — (For department use)
IV. IDENTIFICATION — To be completed by all applicants
Name Mailing address strc-c>t, cit%, tmt/ ltcatc ZIP code Tel. No.
Owner or
Lessee
LBcense,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
Xr
ll
j
D0 NOT WRITE BELOW THIS LINE
V. PLAN REVIEW RECORD — For office use
Plans Review Re uired Check Plan Review Date Plans By Plans B Notes
9 Fee Started y Approved y
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 LJ
VII. VALIDATION
Building
Permit number
Building C
Permit issued 19
Building
Permit Fee $
Certificate of Occupancy S
Approved by:
Drain Tile S
Plan Review Fee S—
TITLE
City of Xort4ainptou
� � �A'ilass�[cllusetts
Offire of the 'Noptrtor of 'Pulilbings APPLICATION FOR
ZONING PERMIT AND
Page Q;&5--d Plot >/G BUILDING PERMIT
IMPORTANT — Applicant to complete all items in sections: 1, 11, III, IV, and IX. Z
O
, --,
1• AT (LOCATION) ( .� ZONING J
`7 1L % DISTRICT
LOCATION (N0.) (STREET)
OF BETWEEN AND
BUILDING (CROSS STREET) (CROSS STREET)
LOT
SUBDIVISION LOT BLOCK SIZE
11. 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
2 ❑ Addition(If residential, enter number 12❑ One family 18 ❑ Amusement, recreational
of new housing units added, if any,
in Part D, 13) 13rTwo 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>K Repair, replacement or dormitory - Enter number
5 F-] 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)
16F_-] Car � i/ 24❑ Office, bank, professional
6 ❑ Moving (relocation) p art / L
7 ❑ Foundation only 17N Other - Specify,1-1 "� t- 1. 25❑ Public utility
i
26 ❑ School, library, other educational
B. OWNERSHIP 27 ❑ Stores, mercantile
8 U17r 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,,,••••,,••••,•• < K r t 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 $ Lf Lj,
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
E. PRINCIPAL TYPE OF FRAME G. TYPE OF SEWAGE DISPOSAL J. DIMENSIONS �
/� 1T1
30❑ Masonry (wall bearing) 40 ❑ Public or private company , 48• Number of stories............'
31` Wood frame 41 ❑ Private (septic tank, etc.) y,' /- 49. Total square Feet floor area,
all floors, based on exterior
3L�'❑ Structural steel dimensions j
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
"fl
51. Enclosed ......K:.Z.� .�c:.... r
F. PRINCIPAL TYPE OF HEATING FUEL I. TYPE OF MECHANICAL C,
35❑ Gas Will there be central air 52. Outdoors....., f.�r:.
36 ❑ Oil conditioning? y L. RESIDENTIAL BUILDINGS ONLY
37 ❑ Electricity 44 ❑ Yes 45`, I No 53. Number of bedrooms..............
38 ❑ Coal I
39❑ Other - Specify Will there be an elevator? Full.......... 1
54. Number of
46 ❑ Yes 47 k No bathrooms
Partial.......
_
hereby certify that the proposed work is auAorized-\by the owner-oferecord
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
CITY OF NDRTN Z o DEPT. FILE COPY
BUILDING
xaxTHAWTON t Mi. 01060 25A - 110 PERMIT
VALIDATION
DATE April 3, 19� PERMIT NO. 11
APPLICANT T,ep J. Shet}7 * ADDRESS ��- I� No. F mst Rd.
INC7./ (STREET) (CONTR'S LICENSE)
PERMIT TO R air rch (�) STORY Residence NUMBER OF 2
�p DWELLING UNITS
(TYPE OF IMPROVEMENT) NO. (PROPOSED USE)
AT (LOCATION) M Bridge Street ZONING
DISTRICT
(NO.) (STREET)
o, BETWEEN AND
(CROSS STREET) (CROSS STREET)
a
a. LOT
m SUBDIVISION LOT BLOCK SIZE
V
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
E (TYPE)
it
0 REMARKS: _ Hgw it parch
AREA OR
VOLUME ESTIMATED COST $ 800.DO FEEMIT $ 10.00
(CUBIC/SQUARE FEET)
OWNER M imr Koo.
��� B.;,A BUILDING D P
ADDRESS ,e23 Huge Street, Borthawtong Ma. BY
(Affidavit on reverse side of application to be completed by authorized agent of owner)