17C-095 (8) ZONING •
DISTRICT
eager-
MA.,.
� IX. SITE • • PLOT PLAN For Applicant
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NOTES and Data — (For department use)
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IV. IDENTIFICATION — To be completed by all applicants
Name Mailing address — Niimbc°r, .tiircc°t, (it%, unrl �iatc' ZIP code Tel. No:'
Owner or -----
Lessee
Builders
�• 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 th application as hi authorized agent and we agree to conform to all applicable laws of this jurisdiction.
Signatur r'app icant Address Application date
�L c�
DO NOT WRITE BELOW THIS LINE
V. PLAN REVIEW RECORD — For office use
Plans Review Required Check Plan Review Date Plans B Date Plans
Fee Started y Approved By Notes
BUILDING
PLUMBING
MECHANICAL
ELECTRICAL
OTHER
VI. ADDITIONAL PERMITS REQUIRED OR OTHER JURISDICTION APPROVALS
Permit or Approval Check Date Number By Permit or Approval Chk Date
ec
Obtained 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 ��� f'
Building
Permit issued 19
Building
Permit Fee $ �0_�C!
Certificate of Occupancy S
Approved b
Drain Tile`
Plan Review Fee
TITLE
of Wort amptau
$ � #�lassxchuset#s
7 Office of the �nsvertor of 'Puilbings APPLICATION FOR
ZONING PERMIT AND
Page f 7 - Plot BUILDING PERMIT
z
IMPORTANT — Applicant to complete all items in sections: I, 11, 111, IV, and IX. O
ZONING
C', ��' - � - D STR Cllf,1\�
I• AT (LOCATION)
LOCATION �1 R�') (STREET)
OF BETWEEN AND
BUILDING (CROSS STREET) (CROSS STREET)
LOT
SUBDIVISION LOT BLOCK SIZE
N
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 ITI
1 ❑ New building Residential Nonresidential
2 ❑ Addition(If residential, enter number 1y 18 ❑ Amusement, recreational
of new housing units added, if any, -�13 7wo or more family - Enter 19 ❑ Church, other religious
in Part D, 13)
number of units- 20 ❑ Industrial _
3 Alteration (See 2 above) 14 Transient hotel, motel, 1-
❑ 21 ❑ Parking garage
4 ❑ Repair, replacement or dormitory - Enter number r
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 Car art
(relocation) 24❑ Office, bank, professional
6 ❑ relocation p
17 ❑ Other - Specify 25 ❑ Public utility
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................ J 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 $
III. SELECTED CHARACTERISTICS OF BUILDING — For new buildings and additions, complete Parts E — L;
for wrecking, complete only Part J, for aft others skip to IV. y
O
E. PRINCIPAL TYPE OF FRAME G. TYPE OF SEWAGE DISPOSAL J. DIMENSIONS I'll
48. Number of stories...............
30❑ Masonry (wall bearing) 40 Public or private company
41 ❑ Private (septic tank ) 49• Total square feet of floor area,
, etc.
31 X 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 ❑ Other - Specify 42 ❑ Public or private company
,
43 ❑ Private (well, cistern) K. NUMBER OF OFF-STREET
PARKING SPACES
51. Enclosed ....................... O
F. PRINCIPAL TYPE OF HEATING FUEL I. TYPE OF MECHANICAL
35 ❑ Gas
Will there be central air 52. Outdoors........................
t'
36X Oil
conditioning? r
L. RESIDENTIAL BUILDINGS ONLY
37 ❑ Electricity 44 ❑ Yes 45 U No 53. Number of bedrooms..............
38 ❑ Coal {
39 ❑ Other - Specify Will there be an elevator? Full..........
54. Number of n
❑ 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 19
DEPT. FILE COPY
Z0
BUILDING
PERMIT VALIDATION
DATE May 18, 19-27 PERMIT NO.
APPLICANT FlawArd TCnnnt, ADDRESS 1,36 ChPStnut
(NO.) (STREET) (CONTR'S LICENSE)
PERMIT TO ��tAr oTiP.-fA.mi V rP_Si �(_) STORY R _sidentia.l DWELLING OF
UNITS 2
(TYPE OF IMPLLR OVEME T) NO. (PROPOSED USE)
ZONING
AT (LOCATION) O .hPatnLt DISTRICT URB
(N0.) (STREET)
a BETWEEN AND
c (CROSS STREET) (CROSS STREET)
a
d LOT
SUBDIVISION LOT BLOCK SIZE
a
U
O BUILDING IS TO BE FT. WIDE BY - FT. LONG BY FT. IN HEIGHT AND SHALL CONFORM IN CONSTRUCTION
O
O
Z TO TYPE USE GROUP BASEMENT WALLS OR FOUNDATION
(TYPE)
0:
LL REMARKS: Addition to rPA.r rnnm - n-dr] nhimney for mod stove - a.cl(j j)a.ti_o
VOLUME ESTIMATED COST $ 3,000.00 FEEMIT $ 10.00
(CUBIC/SQUARE FEET)
OWNER Dnrni:h,y & Rr3wa.rd Xnnnt '^
BUILDING OE
ADDRESS 13() flh ,-,+,m7t. S+.rAPt, Flnrance, Ma, BY
(Affidavit on reverse side of application to be completed by auth gent of owner)