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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 — %'timber, strcct, cifN, rind State ZIP code Tel. No.
O�ner or
1.
Lessee �< Builder's _Qj/
2, V 6 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.
Sig ur of lic nt Address Application date
o��
00 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 Do te
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 April 25F 197_
Building
Permit Fee $ 10.00
Certificate of Occupancy
Approved by:;
Drain Tile S �
Plan Review Fee
INSPECTOR OF' BUILDINGS
TITLE
�o� rOti
Crz � of cKart4amptou
� � ,�[xss�cllixsetts
Offzre of ffipe Jnsprrtor of �OiuilDxngs
APPLICATION FOR
ZONING PERMIT AND
Page _Plot - BUILDING PERMIT
IMPORTANT — Applicant to complete all items in sections: 1, 11, 111, IV, and IX. Q
ZONING
AT
I• AT (LOCATION) I-) te� DISTRIC'1/
LOCATION / (NO.) TREET)
OF BETWEEN_, /!l/IJ AND �Jl%lL tG�L
BUILDING (CROSS STREET) ( ROSS STREET)
LOT
SUBDIVISION LOT BLOCK SIZE
II. TYPE AND COST OF BUILDING — A11 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(IJ residential, enter number 12 q 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— — — — --)� 20 ❑ Industrial NIS
3 Alteration (See 2 above)
14 ❑ Transient hotel, motel, 21 ❑ Parking garage
4 ❑ Repair, replacement or dormitory — Enter number
5 F__1 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) 24❑ Office, bank, professional
6 ❑ Moving (relocation) 16 ❑ Carport
17V Other — SpeciJy 25 ❑ Public utility
7 ❑ Foundation only "� 26 ❑ School, library, other educational 1
B. OWNERSHIP /�1/ x �'�!1 27 ❑ Stores, mercantile
8 0 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,
deportment 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 1$ G'
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
Q
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
31 Wood frame 41 ❑ Private (septic tank, etc.) 49. Total square feet floor area,
all Floors, based on exterior
32❑ Structural steel dimensions ..................... \ i
33❑ Reinforced concrete H. TYPE OF WATER SUPPLY V
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........................
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 47X No bathrooms Partial........
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{
w ASSESSORS COPY
Z0
n-
BUILDING
PERMIT VALIDATION
DATE Urn 251 19 72 PERMIT NO. 1
APPLICANT ADDRESS Um"A
(CONTR'S LICENSE)
NUMBER OF
PERMIT TO * ) STORY DWELLIING UNITS
(TYPE OF IMPROVEMENT) N0. Um (PROPOSED USE)
ZONING
AT (LOCATION)
DISTRICT Xo"b(N N 0. STREET)
a BETWEEN #s �. AND 3xi400 ho"
rn (CROSS STREET) (CROSS STREET)
LOT
a SUBDIVISION LOT BLOCK SIZE
m
0 BUILDING IS TO BE FT. WIDE BY FT. LONG BY FT. IN HEIGHT AND SHALL CONFORM IN CONSTRUCTION
O
m
Z TO TYPE USE GROUP BASEMENT WALLS OR FOUNDATION
(TYPE)
0
LL REMARKS:
AREA OR PERMIT
VOLUME ESTIMATED COST $ FEE 41 _
(CUBIC/SQUARE FEET)
OWNER D mrtba Alklrs
BUILDING DEPT.
t
ADDRESS 2 Is ° �rmat, z1amomm BY
3 t e
k §} i
r �
R�
y 1 �
�t
r
AM
ML
Pr
tn
h
a
$ �1k
1
4
aaX x c "
50
R "�jf
S s t ';€
M ON
"t
�x�
V
I hereby certify that the proposed work is authorized by the owner of record
and l 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
,. A
— DEPT. RLE COPY
!� Z C3
BUILDING
PERMIT VALIDATION
DATE A=il 25, 19 22 PERMIT NO. 132
APPLICANT Bobprt ? Martin ADDRESS 19K Ainrt.h Man) a '-twee:
INO.) (STRE ) (CONTR'S LICENSE)
PERMIT TO Residence - lt.eration NUMBER OF
$__) STORY Ftw�aident.ial DWELLING UNITS
(TYPE OF IMPROVEMENT) NO. (PROPOSED USE)
ZONING
AT (LOCATION) DISTRICT
(NO.) (STREET)
m BETWEEN Main ';+rpAt AND 4a-Road
(CROSS STREET) (CROSS STREET)
LOT
a SUBDIVISION LOT BLOCK SIZE
m
a
0 BUILDING IS TO BE FT. WIDE BY FT. LONG BY FT. IN HEIGHT AND SHALL CONFORM. IN CONSTRUCTION
O
m
O
Z TO TYPE USE GROUP BASEMENT WALLS OR FOUNDATION
f (TYPE)
I
O
a REMARKS:
AREA OR PERMIT
VOLUME ESTIMATED COST $ FEE n n --
(CUBIC/SQUARE FEET)
OWNER FrannPC Ti 17 E+ & 17nrnthea A 1 ki re
'� BUtLDIN EP
ADDRESS 125 Nnrhh Merril v Street, PI OX'enaga BY
(Affidavit on reverse side of application to be completed by out agent of owner)