25A-190 (34) ZONING
DISTRICT
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SIDE r SIDE YARD
REAR YARD
IX. SITE • ' PLOT PLA For Applicant
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NOTES and Data — (For department use)
IV. IDENTIFICATION — To be completed by all applicants
Name Mailing address — Nurnbcr, strcct, ( it%. and CIatc -- ZIP code Tel. No.
Owner or � � Lb4 dam.
Lessee
i
Bui Ider's
L,
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
(i DO NOT WRITE BELOW T IS LINE
V LAN REVIEW RECORD — For office use
Plans Review Re wired Check Plan Review Date Plans B Date Plans B Notes
q Fee Started y Approved y
BUILDING
PLUMBING
MECHANICAL
ELECTRICAL
OTHER
VI. ADDITIONAL PERMITS REQUIRED OR OTHER JURISDICTION APPROVALS
Date Date
Permit or Approval Check Obtai 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
Building
Permit issued 19
Building
Permit Fee
Certificate of Occupancy S
Appro "1
Drain Tile
C�1i LL' s
Plan Review Fee S—
TITLE
(rity of Xoxt4ain tun
� � �lr;ssxclfnsetfs
t QOffire of the #nspertor of Vuilbings
APPLICATION FOR
ZONING PERMIT AND
Pag Plot BUILDING PERMIT
IMPORTANT — Applicant to complete all items in sections: 1, 11, 111, IV, and IX. p
ZONING
I• AT (LOCATION)_,/ c// �°�-" � � (� D STR C
LOCATION (N0.) (STREET)
OF BETWEEN AND
BUILDING (CROSS STREET) (CROSS STREET)
LOT
SUBDIVISION LOT BLOCK SIZE
Vl
II. TYPE AND COST OF BUILDING — All applicants complete Parts A — D
A. TYPE OF IMPROVEMENT D. PROPOSED USE — For"Wrecking" most recent use M
I
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) 13 Two or more family — Enter 19 ❑ Church, other religious
number of units— — — — —o- 20❑ Industrial
3 ❑ Alteration (See 2 above)
14 ❑ Transient hotel, motel, 21 ❑ Parking garage
4 ❑ Repair, replacement or dormitory — Enter number 22 ❑ Service station, repair garage
5 ❑ Wrecking (If multifamily residential, of units ——————— — --�
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 ❑ Public utility
7 ❑ Foundation only
26 ❑ School, library, other educational
B. OWNERSHIP _ l C 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
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 insealled 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 $ 0'?J_0
III. SELECTED CHARACTERISTICS OF "ILDING — For new buildings and additions, complete Parts E — L;
for wrecking, complete only Part J, for all others skip to IV. y
E. PRINCIPAL TYPE OF FRAME G. TYPE OF SEWAGE DISPOSAL J. DIMENSIONS M
m
30�]Masonry (wall bearing) 40 ❑ Public or private company 48• Number of stories...............
31 ® Wood frame 41 [X 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........................
conditioning?
36 ❑ Oil L. RESIDENTIAL BUILDINGS ONLY
37 Electricity 44❑ Yes 45 `}( No 53. Number of bedrooms.............
38n Coal
39 ❑ Other — Specify Will there be on elevator? 54. Number of Full..........
46 ❑ Yes 47 FV'i No bathrooms
77�� Partial.......
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I hereby certify that the proposed work is authorized.b� the owner. .of ,record
and I have been authorized by the ov�ner to make this 6ppIUdtion -cis his'
authorized agent.
SIGNATUR) OF AGENT -r
ADDRESS
(NUMBER) (STREET) (CITY)
APPROVED BY TITLE
DATE 19
On
Z
DEPT. FILE COPY
"CITY of NORTHANPTON BUILDING 0
NoRTHAmpm, r&, mho 2 61 PERMIT VALIDATION
DATE April gK 197- PERMIT NO. le-4 (C�---
APPLICANT Tnhn R- Zalesky ADDRESS 101 O �`+�er= Road
(N0.) (57R EET) (CONTR'S LICENSE)
NUMBER OF
PERMIT TO Altair Rrasident*e (1_) STORY p1mrah DWELLING UNITS L
(TYPE OF IMPROVEMENT) NO. (PROPOSED USE)
ZONING URA
AT (LOCATION) 101 Old Ferry Road DISTRICT
(NO.) (STREET)
m BETWEEN AND
m (CROSS STREET) (CROSS STREET)
LOT
m SUBDIVISION LOT BLOCK SIZE
4
V
O BUILDING IS TO BE FT. WIDE BY FT. LONG BY FT. IN HEIGHT AND SHALL CONFORM IN CONSTRUCTION
Ri
Z TO TYPE USE GROUP BASEMENT WALLS OR FOUNDATION
(TYPE)
OL REMARKS: Add Si dss and roof t0 existing a=oreh
AREA OR ESTIMATED COST $ t,n�fl REMIT
VOLUME , �nQ
(CUBIC/SQUARE FEET)
OWNER John & I I imabeth Zaleajgc BUI 1 T
ADDRESS 1 c 1_nm }AEI= Road., NorthSl'12rTt011, MS. BY
(Affidavit on reverse side of application to be completed by authorized agen zf owner)