17C-037 (4) ZONING •
FRONT DISTRICT
SIDE - . SIDE YARD
REAR - .
NOTES
IX. SITE OR • ppl-icont Use
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"e'ue2?t Proposed
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[= etv Council (�,-reci?1 .C,'t)r� or;
Yes T'o
atershed Protection District �` 1 3, ( .0 . Sect.
Space Feouiremento: (5'..C`. . _cct. - �1) - --- t=e,, ,i_ d _—_— Ir ose ?
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This m ction for OF71CI III
_,
j Approval as preseiAc d:
odifica.tions n- 1cc , ,- fc,r
I ore infn1n; ti -T) ,�.,_: r!icd)
[� Denial • ,e c- r._
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i
IV. IDENTIFICATION — To be completed by all applicants
Name Mailing address — A'ucnbcr, strcc°t, ritN, aml Ctafc IP code Tel. No.
Owner or ,� �e- 6-
Lessee
��' n—/ Bullde i
L. J J!�/.� -�'v.. .,;.lJ, j License N s o.
Contractor '` g 1 —
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
ZZ
DO 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
Building
Permit issued 19
Building
Permit Fee
Certificate of Occupancy S
Approved
Drain Tile
Plan Review Fee _
TITLE
e Cr itV of Xo rt4amvtorY
a r
$ � �[sssarl)ttsetts
Office of the lns}lectox of �Axulailgp APPLICATION FOR
ZONING PERMIT AND
Page�PI0t BUILDING PERMIT
z
IMPORTANT — Applicant to complete all items in sections: 1, 11, 111, IV, and IX. O
ZONING
I• AT (LOCATION) DISTRICT—
LOCATION
/� —P �C �
LOCATION (NO' STREET)
OF BETWEEN AND (CROSS STREET)
BUILDING (CROSS STREET)
LOT
SUBDIVISION LOT BLOCK SIZE
N
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 new housing units added, if any, 13❑ Two or more family – Enter 19 ❑ Church, other religious
in Part D, 13)
number of units– – – – --> 20❑ Industrial
3 QAlteration (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
(relocation)6 ❑ relocation p ❑
17 ❑ Other – SpeciJy 25 Public utility
7 ❑ Foundation only 26 ❑ School, library, other educational i
B. OWNERSHIP 27 ❑ Stores, mercantilev
28 ❑ Tanks, towers '
8 [e Private (individual, corporation,
29 Other – SpeciJy
nonprofit institution, etc.)
❑
9 ❑ Public (Federal, State, or
local government)
C. COST (Omit cents) Nonresidential – Describe in detail proposed use of buildings, e.g.,. food J
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 $ b1"', 3C
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.............
30[-:] Masonry (wall bearing) 40 Public or private company
41 ❑ Private (septic tank, etc.) 49. Total square feet of floor area,
31 Wood frame all floors, based on exterior
32❑ Structural steel dimensions ....................
33❑ Reinforced concrete H. TYPE OF WATER SUPPLY
50. Total land area, sq. ft. ...........
34 F__1 Other – Specify 42 Public or private company
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..........
❑ bathrooms
46 Yes 47 ❑ No 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.
SIGNATURE OF-'AGENT
ADDRESS
(NUMBER) (STREET) (CITY)
APPROVED BY TITLE
DATE 1g
r. F
Zo
DEPT. FILE COPY
} BUILDING 0 4
PERMIT VALIDATION
DATE Aimril 1,9- 19-2 PERMIT NO.
APPLICANT_ Neal Tarattl+ ADDRESS Nn. Rd 9 Bp1ChP_r+nwrl
(N0.) TREET) (CONTR'S LICENSE)
NUMBER OF
PERMIT TO Al r .+ion-RPCidPnCB(i) STORY RAsi n _ _ DWELLING UNITS
(TYPE OF IMPROVEMENT) NO. (PROPOSED USE)
ZONING
AT (LOCATION) iZ� Nn• M8 116 Street, I�'1CLanCe DISTRICT IMR
(N0.) (STREET)
a BETWEEN AND
m (CROSS STREET) (CROSS STREET)
a
IL LOT
m SUBDIVISION LOT BLOCK SIZE
a
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
f
x (TYPE)
O REMARKS: A1+,P_ratinn + RPCidPnrnP
AREA OR PERMIT
VOLUME ESTIMATED COST $ 2000-00 FEE $ 1Q oo
(CUBIC/SQUARE FEET)
OWNER Mike Raper
BUi
ADDRESS — 113 NO. Male Street, Florence e
(Affidavit on reverse side of application to be completed by authorized agent of owner)