25C-168 (3) ZONING •
•
FRONT •
SITFE YARD SIDE YARD
IX. SITE OR PLOT PLAN For Applicant
� _ iS::::S:::i::i i
.. •n H noNr ouawuairnt
• • ■•• Nrs tt/NrN■t arN■HNa■N■t•
sss/oona:i
�iSi1.SS saiS �i� iS�ij:•r�is�::: :i:�s•�ii:i:isiii:iii�i:iuii
r • a►r _r7i r■ r� ..I irii sriS:wsii:�iiiisiiiii:i
• . ■• • as • NH H■ ua ■ai�u1• :H.HN•!a■•.H■
i • ■ r •• . • arra owl
■:uH.i.•H•or•H.a••o:...
r is��• .i'r luS�lrrn=rf•wa■=i■.■Hiu.rn■
R: �:3`# a ■! r • ■ • .r N• NN sHH• wa■r■nno ■aH•
� ■ . ■ • r • s i0# r r0 ■Hr■HHH•■rr.N■tl
IBM iN■Mr
��i ::�i : ��lr1aurl�r:�=■.::=I�n• r/N•N.NH■N#Nn.
: iir ri:::r� � iaa me ease n.:■�•1■.HH.r.Nnna�■
n r • rH■ .r•H■ ru/nH.rNUar •
n !ra •alr.• ..■ it ■u �NS •rH.i • HN HH.HH■HnNN.Ntua rH
�r: N•.•:��1 ' i" ti• Mon.:H pia �iasH�noawH•ouiurN:wH
• r �•.• !fi�r{{�•11 •gi•�nrH•e r.H■HrH■nruuH.r■
1 r■ a :S•S!S nll:rr f : f Sa1•N• .w ..!■N■rHa.N.NNta's mass
w N•NN ■ •• • ■r H NH_ HN/H•ilaNHN■/■M.H■1r
• r Ss :ra a ::r:• SS r R.�rya•:rr• =Ir a it •: ri■�: /Ha■.NII/■/tt■NSar.■trN/■•
f i Nn .�fN.■r•.■ j Ul ■N� rnfrraH■•-a .•■N n•H/
■ • ■ r . f S ar •.iH rt•■H■/r//a.NHrrH■•N•s•.
w • sa !n • .H• i•r•�•�■ r !;jj/1af•• w■■/ fHNS■.s■rr!NHNrruuosH.N•■
•:: r■i:i:: : t. � �N+,1■ �� Si S SirN■NruHNNNNaH.NHHHNN
r■ s i ••:�r�l a � 1�. ur H = =�S ■ a■ oQ■=iri:::■i:i: NaHHNUr •
�r ��i� ■r ��•f � ::nH•■n■r•.:■
rj ••� Gii ;i� ____ • • •� ■ � +�a�#i•niHNrrHnriou■!.■
1�7 is n• a• r.r{{.au•u■H■ ■usuu
t■ ar • . ■ • i aH N• ■ r•r ■#S•r■■/H•Nr■H■H Nwasr
1 • t H. H NH w■ N • H/N •••a•a 111•••Hr •N■■•HHHH
S • SSHaN:::s•: ■::HHN•N!H•■
* Hnn•=• ■• H• sHHHH/r.OHH
is � � � : H : ��0'•SS:• s=!�a■.3'�IN. ru•N.uaNHNH
1w . M • ■ �• •/ i•• • / NN N•Ht•HNO■H aH/••
.:■Sr: r : :S:.r �r�rrrii f n■ MrrM•aH.•NNOr ,H/iN/,HHran/
• .S••1 M t1I� �rS •■ '�•'�' ■-N.H•.•. : ■.na■.wuna•t
a •�.r■•u/�....j Sp•:: r i is i' ii ': .t s i1if1 H::•H:r s�Slr;tSSSia/�iSSiiiii=ii
a.#la•11•.aHHrSN11•NrH ft H ■■ sr a::NS::w•::R# ■auatte•Ht■■ of
. . H HS i1SS
' SS••S' �• �•1!�•t.! �I•N a:I•:a:..;/•:HISII•::.S R�■:'■I!IIn■wI sI•lIlI:•.H•riar:a:S :•"�jS S•wrH!war•ru■i Hl N ro s,S Sn �H�a �r • 'SRu••.■�•• Har#r H■•s•H w S■N■H.rr■•.lH■H.r.•ts .•�■H,a�•`m■!
H •us■s.•. rH "� ur
H r• /�.•
H a r■tr.r 1• a//rrNaaYYY
1 S : :: • : :NHH••S r:::i■SSriS:::rr n. ::rr::: :: ::r':i1: /®wSS:rl SSrrS::�::i::. n/■:S
1 •r !a 1 iu : :'ASS: : :° r S ■'•::: .:wr:::a HS::::::
°-iiiiSHSS .iL7�sisii•�i •u �H H r ai'•ii wZ '�i �� ��Stia .S ■
1■ • ■a■ • S.arSHa/O::•r:aw•! S H ■ •H ■ H •H•H.■•■r■■•N.1a■.•
• R r •Nr wry gl�__ ::I�sI ::s�l:me a 9 • • : ■ • i. � •• nuuoHNH■
•af..� ■"Ri On an
■aa■ge.r+ ■.• =Nal��,■Hnransiwur•
■■■�� •■ n■#Hw■i.•N•:Sr:r■man r � rw■ SS�rSSias:1S:SNS\■t:S:r
r �� • :: r r :::r::=:r S: r�S•��i1=Iii:� i:iS=Siis=nrrS :inS
ii _ ■ iiw � �� ia �:•�i_ �r � i ■ ■ ■ •Gw.wrr
'1 f. • S •:s n H:!•a ■■ ■ r . r •H Nl•H:H.iwi�,■I.i..
' r::•r:::i• :s
i 1 s r ±�■_■ ■ • HResutl iii:::a.:�
:r _ 1R�n•�� s . • �iI • g�H N::.•�■•s::S:si
�� .H ■ rw . r�rr • r rH. !t ua !�
i� SiS � r�ir .=�ia■i:i:�i
�, err • s:rr aiii:i=suni
1 y��•.� .r H• MtH .H
�1 � �1/1rM a n � n■Rrrn•:uR:a
■ ��� HN■r■rar.NH 1
ouuun . ili
"__iii:::i:i::Nisi.
• : ; ' r:sa'� ::a'9
an
:'s'i='esii
:rri 1
Man. . :�
aw
r i:a: Si
�a�"_ � _ a
NOTES and Data — (For department use)
IV. IDENTIFICATION – To be completed by all opplicar#s r-�
Name Mailing address — .Aiimb -r, sheet, rit%,ci rl Slur• ZIP code Tel. No.
Owner or � �
Lessee
Builder's
2. License No.
Contractor GZA (,t-w- ,
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
D0 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 / 197 7
Building
Permit Fee
Certificate of Occupancy S
Drain Tile S App r` by. �...
r_ t
Plan Review Fee S—
TITLE
o� ro
Crity ofx6prt4alliptar
$ � �IassridTnsetfs
`b
1�t Offire of the 11nspertor of {guilaings APPLICATION FOR
Pag ^5 C Plot 161-S, ZONING PERMIT AND
BUILDING PERMIT
z
IMPORTANT — Applicant to complete all items in sections: 1, 11, 111, IV, and IX. 0
r— ZONING ZONING lal
AT (LOCATION) L/ Y x5 4j C `iy(� �' f"4 DISTRICT
LOCATION (NO') STREET)
OF BETWEEN 1 a cE�C• ,r '� ;'L.. - - -� 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(IJ 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 (if multifamily residential,
of units ——————— — --� 22 ❑ Service station, repair garage
enter number of units in building in 15 Ga�ace� 23 Hospital, institutional
Part D, 13) 24❑ Office, bank, professional
16 Carport
6 F-1 Moving (relocation) ❑ 25 E] Public utility
17 Other — SpeciJy
7 ❑ Foundation only 26 ❑ School, library, other educational
B. OWNERSHIP 27 ❑ Stores, mercantile
8 K 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
` S processing plant, machine shop, laundry building at hospital, elementary
"'
10. C ✓n1{.e8 t' 1 �` `� 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..................... 7 �,ry
lk b. Plumbing ..................... �® X13
c. Heating, air conditioning.........
i
d. Other (elevator, etc.)............
11. TOTAL COST OF IMPROVEMENT $� h
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. D
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
41 Private (septic tank, etc.
31 Wood frame ❑ ( p ) 49. Total square feet of floor area,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 ....................... 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..........
46 ❑ Yes 47 ❑ No bathrooms Partial........
r .
84
�k
r
t
'1 vw
ti a
Mry�.a�i.�
IP
""
Me-
TWE
IMP
4 # v<
}^e r y
rT
N �
2,1
v
sew
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
(NUM ER) (STREET) (CITY)
APPROVED BY TITLE
DATE 1g
F"
�j"
DEPT: FILE COPY
Z
PERMIT VALIDATION
DATE 1,3 77 PERM O.
APPLICANT ADDRESS SP� 1 +
(NO.) (STRE T) � (CONT R'S LICENSE)
NUMBER OF
PERMIT TO ) STORY DWELLING UNITS
(TYPE OF IMPROVEMENT) NO. (PROPOSED USE)
ZONING
AT (LOCATION) 32— —3 // 8
DISTRICTr•�
(NO.) (STREETS _
a BETWEEN AND
-�o (CROSS STREET) (CROSS STREET)
a
LOT
IL SUBDIVISION LOT BLOCK SIZE
m
a
u BUILDING IS TO BE FT. WIDE BY FT. LONG BY FT. IN HEIGHT AND SHALL CONFORM IN CONSTRUCTION
O
CD
Z TO TYPE USE GROUP BASEMENT WALLS OR FOUNDATION
Ilk
(TYPE)
I ,�
0 a� S ,299,0-
L- REMARKS:
� ® -�► PERMIT
AREA
VOLUME ESTIMATED COST $ v w FEE �p
(C IC/SQUARE FEET)
1
OWNER BUIL AID
:S
BY
(Affidavit on reverse side of application to be completed by authorized agent of owner)