17C-176 (3) VIII. ZONING PLAN EXAMINERS NOTES
FRONT DISTRICT
USE
SIDE 'D SIDE YARD
REAR YARD
NOTES
IX. SITE OR PLOT
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NOTES and Data — (For department use)
TT
R
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[ _] )'.Ip1_ex Gthei
i._.. .
1
--� iv _•lion [� Regul .=.r
I .U.D.
�] Plal)nilig ,"oord Approvr,.l ;
[_] Zoning 1�0�,rrd Approval (Speei l Pc'1rlit 1(). ; V�ri:�r ce)
� Special F;;ccpt:i_on S. 1C 1.O1
l City Council (
ra ter shcd Protection District Overlgy : ( r.0. Scct. _:IV)
E� YCs � � T'o
ParkinL, Space Pequirementc: (/,.0. ,;Oct. :'.I)
1,oading Sp,9ce Pcquirement, I o. sect. 2
Si�,r.s: _�Z.G. Arta vI_I�— ---- �_� Yec L A ilo
- - ---- --- -- ----- ------------------
Fnvirol rnfntal Perforc,iancE Stand rd�:— (7 G. art, YJ �- — Yes �_�1Io
Plot Plan Yes to Pl.-)II �__- � Pes �_�'1 0
(S. 10. 2)
I B A I L i Ems. 1 V i 1—�2 K- I X [ _:c t I t rA
` nir section fo.r GFFJCIAL u,e 03)l3-:
pre cctArd:
( -
Ailodificatioils ncce"�r.�ry ir,r "hl1inv;ll•
) Return: (More infolmti n nc ccic_c1)
[ Denial : Rer)r.ons;
S
� 77
S!,_i:"'.fllrf of p). ) 3 i.0 7111 t• - D1te ��� >1 r,_''t:iir ) f l '1 Mlle Uffi-C( r 1) -e
IV. IDENTIFICATION — To be completed by all applicants
Name Mailing address — Number, sfrccl, citN, aml State ZIP code Tel. No.
Owner or •
Lessee V(�
Builder's
2• N 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
L
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 181
Building
Permit issued May 26, 192_
Building
Permit Fee $ 10.00
Certificate of Occupancy S
Appro e y:
Drain Tile
Plan Review Fee
—
LOCAL INSPECTOR
TITLE
O� TO
$ � �'ilass�tcifttsetfs
of
T` • OffiXe of the �nspectox of Auilbiugs APPLICATION FOR
Page 7 G Plot /7 G ZONING PERMIT AND
BUILDING PERMIT
z
IMPORTANT — Applicant to complete all items in sections: 1, 11, 111, IV, and IX. /� O
ZONING K Uj
I• AT (LOCATION) — (STREET)
LOCATION (NO.)
OF BETWEEN AND
BUILDING (CROSS STREET) (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 Alteration (See 2 above) 14 Transient hotel, motel,
❑ 21 ❑ Parking garage
4 ❑ Repair, replacement or dormitory — Enter number
5 ❑ Wrecking (IJ multifamily residential,
of units ——————— — --* 22 ❑ Service station, repair garage
enter number of units in building in 15❑ Garage 23 ❑ Hospital, institutional r
Part D, 13) 24 ❑ Office, bank, professional
6 Moving (relocation) 16 ❑ Carport
❑ 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,,,,,,,,,,,,,,,, OV• 0 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 $ "'00.00
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
31 Wood frame 41 ❑ Private (septic tank, etc.) 49. Total square feet floor area,
all floors, bused on exterior
32❑ Structural steel dimensions .....................
33❑ Reinforced concrete H. TYPE OF WATER SUPPLY
42 Public or private company 50. Total land ores, sq. ft. ...........
34❑ Other — Speci/y � p
43 (❑ Private (well, cistern) K. NUMBER OF OFF-STREET
PARKING SPACES
51. Enclosed ....................... r
F. PRINCIPAL TYPE OF HEATING FUEL I. TYPE OF MECHANICAL 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..............
36 ❑ Coal
39 ❑ Other — Specify Will there be an elevator? 54. Number of Full..........
46 ❑ Yes 47 ❑ No bathrooms Partial........
I hereby certify that the proposed work is authorized by the owner of record
and 1 have been authorized by the owner to make this application as his
authorized agent.
SIGNATU9E..OF` AGENT . ..- ,. .
ADDRESS
(NUMBER) (STREET) (CITY)
APPROVED BY TITLE --
DATE i 9
— — F DEPT. FILE COPY
ZO
BUILDING fa
PERMIT
VALIDATION
DATE May 26, 19 77 PERMIT NO. 18f
APPLICANT R'C�bert C, Dttirkee ADDRESS �0 FAA rPi
N0.) (STREET) (CONTR'S LICENSE)
NUMBER OF
PERMIT TO R,.Pnnvat.e RfsidPnrP (2_) STORY Residential DWELLING UNITS
(TYPE OF IMPROVEMENT) NO. (PROPOSED USE)
AT (LOCATION) 30 Fairfield Avenue ZONING URB
D ISTR ICT
(NO.) (STREET)
rn BETWEEN AND
(CROSS STREET) (CROSS STREET) .
a
IL LOT
m 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
m
O
Z TO TYPE USE GROUP BASEMENT WALLS OR FOUNDATION
I (TYPE)
Ir
REMARKS: Add cm 1,01 X 101 for a. dining area
AREA OR
VOLUME ESTIMATED COST $ Zr�r1Q0.nn FEEMIT 1,0.00
(CUBIC/SQUARE FEET)
OWNER Robert C. Durkee
BUILD
ADDRESS 30 Fairfield A-v _nup, Florence- BY
(Affidavit on reverse side of application to be completed by authorized agent of owner)