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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. LSign'alure of applicant Addr ss Application date V. PLAN REVIEW RECORD For office use Plan Review Date ions Date Plans Plans Review Required Check Fee Starpted By Approved By Notes BUILDING $ PLUMBING $ MECHANICAL $ ELECTRICAL $ OTHER 1$ 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 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 L�JAt 19 Building Permit Fee $ Certificate of Occupancy S Approved by: Drain Tile Plan Review Fee TITLE 0 ` e (rity of X)art4allivtott l:;ss �tftts�tt� is T' Offire of the �ns}rertor of 'Puilbings APPLICATION FOR ✓V .3 1 ZONING PERMIT AND Page_ Plot _ BUILDING PERMIT IMPORTANT — Applicant to complete all items in sections: I, 11, 111, IV, and IX. Z O ZONING A ,M .,- , a I. AT (LOCATION) DISTRICT�! -' _�_( �^. LOCATION (NO.) (STREET) d r OF BETWEEN O�t !` CC° Gj`a / AND f e-C BUILDING (CROSS STREET) (CROSS STREET) LOT `p' i\ I J ` SUBDIVISION LOT BLOCK SIZE l_ y 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 Residential Nonresidential 2 Addition(If residential, enter number 12 ❑ One family 18 ❑ Amusement, recreational of neu, housing units added, if any, in Past D, 13) 13 ❑ Two 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 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) 16 ❑ Carport 24 Office, bank, professional 6 ❑ Moving (relocation) 25 ❑ Public utility 17 F__1 Other — SpeciJy 7 ❑ Foundation only 26 ❑ School, library, other educational B. OWNERSHIP 27 ❑ Stores, mercantile 28 ❑ Tanks, towers 8 ❑ Private (individual, corporation, 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,•••,•.......... 1+¢C'tie, C f' 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..................... �1 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. y O E. PRINCIPAL TYPE OF FRAME G. TYPE OF SEWAGE DISPOSAL J. DIMENSIONS M 48. Number of stories................ f 30 Masonry (wall bearing) 40 S Public or private company 41 Private se tic tank, etc.) 49. Total square feet of floor area, 31 Wood frame ( P all floors, based on exterior 32❑ Structural steel dimensions ..................... C.G., 33❑ Reinforced concrete H. TYPE OF WATER SUPPLY 34 F__1 Other — Specify 42 � Public or private company 50. Total land area, sq. ft. ........... 43 Private (well, cistern) K. NUMBER OF OFF-STREET PARKING SPACES 51. Enclosed ....................... f� F. PRINCIPAL TYPE OF HEATING FUEL I. TYPE OF MECHANICAL 0 35 Gas Will there be central air 52. Outdoors........................ 17 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 4 No bathrooms Partial....... r I hereby certify that the proposed work is authorized by the owner of record { and I have been authorized by the owner'.'to- roWL' this apptir6fl off: authorized agent. SIGNATURE OF AGENT. ADDRESS __ u (NUMBER) (STREET) (CITY) APPROVED BY TITLE DATE 19 DEPT. PILE COPY Z O CITY (W NORTAMPTON BUILDING M a NORTfWaWN, MM�F. 23B - 44 PERMIT VALIDATION DATE Septmber 21, 1T9� 7 PERMIT NO. APPLICANT I+owist �1'I'r7 ast A ssaclates ADDRESS locust (NQ. (STREET) (CONTR'S LICENSE) -I— P=feelgyni4 M? NUMBER OF PERMIT TO (-I—) STORY �ff DWELLING UNITS (TYPE OF IMPROVEME NT) NO. (PROPOSED USE) ZONING IQf AT (LOCATION) 41 La DISTRICT NB (NO.) (STREET) tom a BETWEEN N©+ KIM AND_1ka,.st- 'D (CROSS STREET) -(CROSS STREET) a I a LOT m SUBDIVISION LOT BLOCK SIZE 1 50 15 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) Ir LL REMARKS:Arid util.3ty lab 2511 X !1—$ 4", A-Ad entry 61 X--554' AREA OR VOLUME ESTIMATED COST $ 18.000 FEEMIT .Q. 54.00 (CUBIC/SQUARE FEET) P .T' OWNER LOCUS t S'h'eet ASSOCIates BUI ING P7. ADDRESS BY (Affidavit on reverse side of application to be completed by a lzed agent of owner)