32C-201 VIII. ZONING PLAN EXAMINERS NOTES
DISTRICT
USE
FRONT YARD
SIDE • . SIDE
REAR YARD
NOTES
IX. SITE OR 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 Moilinga_ddress — .''umber, strrcf, rite, and Stan• ZIP code TLSI. No.
I. �ej ,. , fi rC CC++K.r XLr
Owner or 7
Lessee
Builder's
2. 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
� 0 NOT WRITE BELOW THIS LINE
V. PLAN REVIEW RECORD — For office use
Plans Review Required Check Plan Review Date Plans B Date Plans By Notes
Fee Started y Approved
BUILDING
PLUMBING
MECHANICAL
ELECTRICAL
OTHER
VI. ADDITIONAL PERMITS REQUIRED OR OTHER JURISDICTION APPROVALS
ate Date
Permit or Approval Check ObDta ned 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 j�
Permit number '•�
Building - y
Permit issued / C'-
Building L
Permit Fee
Certificate of Occupancy
Appr by:
Drain T i l e
Plan Review Fee _
TITLE
�o� roy
Crx of Xort4ainptou
� � !1�[xssadfnsetfs
7 " Offire of the 41no ertor of Auildiugs
APPLICATION FOR
ZONING PERMIT AND
Page ,-Z �- Plota I BUILDING PERMIT
IMPORTANT — Applicant to complete all items in sections: 1, 11, 111, IV, and IX. Z
O
I• AT (LOCATION) !t•- °'-.. '"1 D STRG 6��,
LOCATION (NO.) (STREET)
OF BETWEEN AND
BUILDING (CROSS STREET) (CROSS STREET)
LOT
SUBDIVISION LOT BLOCK SIZE I CA
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
A
1 New building Residential Nonresidential
2 ❑ Addition(If residential, enter number 12tKOne 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 22 Service station, repair garage
5 F-1 Wrecking (If multifamily residential, of units ——————— — -i
enter number of units in building in 15❑ Garage 23 ❑ Hospital, institutional
Part D, 13) 16 ❑ Carport 24 ❑ Office, bank, professional
6 ❑ Moving (relocation)
17 'Other — SpeciJy / 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.) �riOO �'�� 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,••............. I &l: 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; V
for wrecking, complete only Part J, for all others skip to IV. D
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, V+
31 � Wood frame all floors, based on exterior
32❑ Structural steel dimensions .....................
33 F__1 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 ....................... r
F. PRINCIPAL TYPE OF HEATING FUEL I. TYPE OF MECHANICAL O
35 ❑ Gas
Will there be central air 52. Outdoors........................
36 0 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 bathrooms
47❑ No Partial........
Y
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.
SIGNATURE OF AGENT `
ADDRESS
(NUMBER) (STREET) (CITY)
APPROVED BY TITLE
DATE 19
DEPT. FILE COPY
Z
BUILDING
PERMIT
VALIDATION
DATE MR AZ 1Fi_ 19 72 PERMIT NO. 158
APPLICANT MY'4 Helen Tkaezyk ADDRESS 89 Williams
(NO.) (STREET) - (CONTR"S LICENSE)
NUMBER OF
PERMIT TO �{���y�1mnP_V — (_) STORY EfIr a fi-rP��a.nP DWELLING UNITS One
(TYPE OF IMPRO EMENT) N0. (PROPOSED USE)
p ZONING URC
AT (LOCATION) _89 Wj��iamG --DISTRICT
(NO.) (STREET)
a BETWEEN AND
�o (CROSS STREET) (CROSS STREET)
a
LOT
D. SUBDIVISION LOT BLOCK SIZE
m
u 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
7 (TYPE)
It
LL REMARKS: Arld nhimnpy +,o ana family dew fling to 11GP as a fire-1 at-
AREA ESTIMATED COST $ 600•oo FEE
MiT . O•00
VOLUME E
(CUBIC/SQUARE FEET)
1
OWNER Mrs 14PI Pn Tka e-.,vk Bu
ADDRESS 89 Williams Street F Nor hamptan B «
(Affidavit on reverse side of application to be completed by authorized agent of owner)