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HomeMy WebLinkAbout111 Gorski Drive 0 A° TO THE BUILDING INSPECTOR of the APPLICATION FOR PLAN EXAMINATION AND TOWN OF COS. BUILDING PERMIT z IMPORTANT — Applicant to complete all items in sections: 1, 11, III, IV, and IX. o /��f ZONING • I• AT (LOCATION) ,�( o/Z 5 K I ✓►`, v�i DISTRICT LOCATION (NO.) (STREET) OF BETWEEN AND BUILDING (CROSS S44TREET) •� (CRLOT OSS STREET)SUBDIVISION F0 (,t—Sr Y`/l LLIgcc LOT I J BLOCK SIZE 0" t9(74� N II. TYPE AND COST OF BUILDING — All applicants complete Parts A — D A. TYPE OF IMPROVEMENT D. PROPOSED USE — For"Wrecking" most recent use 1 VNew building Re7dtialNonresidential 2 ❑ Addition([/residential, enter number 12ne family 18❑ Amusement, recreational of new housing units added, i/any, 13❑ Two or more family — Enter 19❑ Church, other religious in Part D, 13) number of units— — — — i 20❑ Industrial 3 ❑ Alteration (See 2 above) 14 l Transient hotel, mote , ❑ 21 ❑ Parking garage 4❑ Repair, replacement or dormitory — Enter number 22 5❑ Wrecking (1/multifamily residential, of units ——————— —-i ❑ Service station, repair garage enter number of units in building in 15 ❑ Garage 23❑ Hospital, institutional Part D, 13) 16 ❑ Carport 24❑ Office, bank, professional 6 ❑ Moving (relocation) 25❑ Public utility 17❑ Other — SpeciJy 7 ❑ Foundation only 26❑ School, library, other educational B. OWN SHIP 27❑ Stores, mercantile 6 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,,.•,••••,,•..., COt> 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 $(,9D eve 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. E. PRINCIPAL TYPE OF FRAME G. TYPE F SEWAGE DISPOSAL J. DIMENSIONS 30 Masonry(wall bearing) 40 Public or private company �• Number of stories.. ........... ❑ Y 9 31 WWood frame 41 El Private (septic tank, etc.) �• Total square het of floor area, all floors, based on exterior 32❑ Structural steel dimensions .................... 33❑ Reinforced concrete H. TYPE,OF WATER SUPPLY 50.42 Public or private company 34❑ Other — SpeciJy Total land area, sq.ft. ........... 43❑ Private(well, cistern) K. NUMBER OF OFF-STREET PARKING SPACES 51. Enclosed ...................... F. PRINCIPAL TYPE OF HEATING FUEL I. TYPE OF MECHANICAL 35 VO . os Will there be central air 52. Outdoors....................... 36 il conditio 'ng? L. RESIDENTIAL BUILDINGS ONLY 37❑ El ct►icity 44 Yes 45❑ No 53. Numb r of b drooms.............. 3B❑ C al 39❑ Other— Specify Will th to be an elevator? Full..^:.... 54. Number of 46❑ Yes 47❑ N bothr ms Partial... .... IV. IDENTIFICATION — To be complet d by all applicants Name Mailing address — Number, street, city,`and State ZIP code Tel. No. Owner orDAY ` �0� r <� O � awe-p- 41 Lessee 2. Contractor 3. L A-550C-AA I e-� (.� 1 1 OAF l L(... ge%t, 1�1 /ILL ►{Z-4 I�t o . cr Engineer The owner of this building and t-he undersigned agree to conform to all applicable laws of this jurisdiction. Signature of applicant Address Application date 00 NOT WRITE BELOW THIS LINE V. PLAN REVIEW RECORD — For office use Plans Review Required Check Plan Review Date Plans By y Date Plans B Notes q Fee StartedApproved BUILDING $ PLUMBING $ MECHANICAL $ ELECTRICAL $ OTHER $ VI. ADDITIONAL PERMITS REQUIRED OR OTHER JURISDICTION APPROVALS Permit or Approval Check ObDtained Number By Permit or Approval Check ObtDained te 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 S�� y Building Permit issued &..L 19 _ Building Permit Fee $ ::7 C '7 Sf3 -00 A ov d LE TOWN OF SOUTH WINDSOR BUILDING PER VHT Date May 41 91987 130 Fee Paid �$. •00 Est. Value $. . . .. ,000.00. Permit N® 15884 on the side of 111 Gorski Drive Lot 113 Street Street No. Owner David ^rases Applicant same as above CERTIFICATE OF OCCUPANCY ISSUED: Date No. 8188 Fee Paid $ 3.00 CLASSIFICATION dwelling Bvu.DiNG PERMIT Y el 15884 OFFICE OF THE BUILDING INSPECTOR of the Town of South Windsor, Conn. South Windsor, Conn. May 21 1987 94io to to Cettthi, That David Fra-Pr is hereby granted permission to dwelling at estimated value of $ 1 1 n,nnn_00 on the side of 111 Gorski Drive Lot #13 Street on land owned by David Fraser Said work to be as described in Application No. 1 b 175 and to conform to spedfications and plans filed with said Application, and Building By- Laws of THE TOWN OF SOUTH WINDSOR. I ued M 19 87 J. Building Inspector. Streets and sidewalks, obstructed by e=vations or building materials, must be guarded by barriers during the day and by both barriers and colored lights by night. SECTION 1343, GENERAL STATUTES OF CONNECTICUT: "When any person shall place or keep building materials, or any obstacle in any highway (or any sidewalk) either with or without a license therefor from the city or borough in which such highway may be situated, he shall pay said city, town or borough all costs and damages which it shall sustain, or be compelled to reason therefor." INSPECTION REPORT Permi# S� Job d &.0rs ilr ptingndation ming ingmbing '"]lo CTD 6 Heating 7 Lathing 8 C.O. /d dwells, /ll &orSk. t'i oc J•o�' (3 FfqLser Permit Electrician me)-v f/ j WFARLANt #/obCy4 H ating Contr. DbK^LP A•D- D:gmp # 705 7 Plumbing " YlCTOk M• !?An aS # 75'71 Oil Burner # C rtiticate of Occupanc is 'A'L # yo I rso, Sewer Permit I P rmit No. TOWN OF SOUTH WINDSOR SOUTH WINDSOR, CONN. Permit N0 81 gyp Certificate Of Occupancy THIS IS TO CERTIFY that the --A j at No. in the been erected and completed in accordance with the Town of South Windsor, Connecticut, has the Town of South Windsor, and is Banchere a Building Code and Zonin Y pproved for occupancy B`Regulations of Owner, Builder Fee Paid Datef 19 CERTIFICI�TE OF OCCUPANCY CHECK LIST Applicant David Freaser Certificate of Occupanc Address 111 Gorski Drive Bldg. Permit No. 1Zoe Lot No. 13 Date Submitted - 1-bb Project ores age Reviewed By ?�Tj Date As required in the Zoning Regulations, no certificate-of-occupancy shall be issued until grading plans have been complied with and approved by the Town Engineer. The minimum requirements shall inlcude: Approved Denied N/A 1. Approved building Permit plan. 2 . Finish grading per approved building permit plan. _ 3 . Site work; i.e. trees, shrubs, dumpsters required parking 4 . Utility location a. sanitary sewer b. foundation drain c. electrical & telephone d. water e. other t/ S . Appropriate certification 6 . Bonding Sewer Permit No. Pavement Excay . No. BUILDING FE-RMIT .C:HECK LIST r Applicant Building Permit No. Address Date Submitted f-7 Lot No , 3 Reviewed by _ R �-k- Project� ;-tr�,�: (7v,..-� _ Date _ �" 2 � "� In accordance with the Subdivision Regulations , prior to the building of any structure on a lot, a Topogr aphic Plot Plan shall be submitted for approval. The minimum requirements shall include : Approved Denied N/A 1. Name , address & phone number of owner/ applicant. 2 . Name , address & phone number of plan preparer. 3. Zoning information - i.e. zone, open space, floodway, etc. _ 4 . Plot plan at 1" = 40 ' scale. a. Subdivision reference, abutting properties , etc. b. Easements of record. C. Lot description, bearings , distances , building lines , area, etc. d. Contours , existing & proposed, 1 or 2 ft . interval where appropriate. e. Building location with dimensions . Elevations of proposed finish floor, garage floor & center line of road at driveway. f. Elevations of gravity drainage systems , sanitary & foundation drain at the house and the street. g. Tentative utility location gas , electric , water, etc . h. Title block with name and address of preparer, date appropriate certification, live seal and signature. -�� 5 . Sedimentation and erosion control . 6 . Special Planning & Zoning, Inland/Wetlands considerations . (Plans on file w/Town Clerk) BUILDING DEPT. P Z C IWA/CC WPCA OTHERS COMMENTS : ELEOTRICAL APPLIGATION Application No. on the Ndt of Ot)R K i Stet Street No. Owner 1 r I rD i" A -2 Z:,�O- Electrician m F/ v'/�� e' Fi4 R FILED IN OFFICE OF The Ruil"g Itupoctor 19 � r+No Electrical Work shall be started until a Per- mit is granted by the Building Inspector. In New Buildings no wiring shall be started until the plumbing and heating pipe% and the Are stops lit of wood) are installed. without a special permit from the oAice of the Building Inspector. Flectr*FA Permit )jm • Master License Na TOWN OF SOUTH WINDSOR Building Permit No. �.�) .. ..� Date Filed BUILDING DEPARTMENT Date Final Appr vs.l ........ ..... APPLICATION FOR ELECTRICAL WORK Electrical Inspector B LOCATION:• ��{' p ......���..�............ .........1'--..� ..-��..�......?�..._. �� JOB OV'�NER. ..��,..� .�..•....... . ...................... Side of .......................................... ........................ Betwe ............................_..........................-...-........._-..- and ---- Name �� 1 .. .... Address Building Owner ... .��..- .�...�1/ Name of B g If work is for Lessee—Give name ......... ._..._._._....._......._...... Address ----•�-� Building now occupied as (unless new) ...._._.. ...-.— —•............._ No. of family units now �._... Building to be occupied a: .........-..- Number of family units to be Is this w rk in u in a Building Permit? ..._•... ..•-•••--. Permit Fee ...-.. �- (If no Bull-i Per*rt• ) Permittee .. � c � Business Address l/O ��AR°•�Ia : Telephow 3 11 COST OF INSTALLATION: .3 7 ...a- cf> ------•---•--• TO BE FILLED OUT BY PERNIT TEE TO BE WIRED EXISTING APPLIANCES Number of light outlets to be installed ••••-••-•• ••--------- Number of present Appliance Circuits ......... Number of convenience outlets to be installed ................. •• Number of switches to be installed . . . ••-• . ........ Do these include Range Q/' Water Heater Number of appliances to be installed ......_.....w--------... (as listed beta_w) Dryer 6Air Conditioner ❑ Oil Burner TYPE RATING NO. Dish Washer (� Gas Burner Range . . . . . . . . Well Pump ❑ Elec. Heaters Range Top . . . . . . Oven . . . . . . . . REMA_R R Water Heater Clothes Washer . . . . Clothes Dryer . . . . . - Dish Washer . . . . . . Air Conditioning Motor . Oil Burner Motor . Gas Burner . . . . . . C.,uculator Motor . . . . Attic r Large Fan , , Well Pump . . . . . . Electric Beat . . . . . Other . . . . . . . . Number of new Lighting Circuits . Number of new Appliance Circuits . . . Number f Heating Circuits • Number f Motor Circuits . . . . • .• • ---- Size f present service .�.--•-•••-•• - e:-- -r - -- •- �- - PLUMBING APPLICATION on the ......_..__...__ sdc of P )VE sa c Street No. .... J I Ownerl&r:1..c FR A 7 ag Plumber Yi-c-i e 9 & o S Filed in Office of • The Building Lrpectar Io� .3a 1907 INiRIECT OIL No person sl~aU ooaasuct, add to at alter ay portion of the drainage system of my 6oOft (except to repair lea6) until a PP dt is greeted by the Building Inspector. APPLICATION FOR PLUMBING. PERMIT (Continued from R verse Sid ) TOWN OF SOUTH WINDSOR, CONN. q OeRSKi 11. LOCATION OF JOB ��� /1O T/J 40 )Q• NO. STREET GENERAL PLUMBING yz O0df1/,;z' ea Af R45 TE 12. KIND OF INSTALLATION OR An /TPA ,0Gp 13. SIZE OF MAIN DRAIN FOvR 13,*7//)900A*I' 14. NO. OF TOILETS _STYLE FJ-d/Ve,4 TE)e 15. NO. OF URINALS STYLE 16. NO.OF BATHTUBS 17.NO.OF LAVATORIES_18. NO.OF SINKS. 19. NO. OF WASHTUBS 20. NO.OF CONDUCTORS SIZE 21. NO. OF STACKS -,�SIZE 22. AREA OF ROOF 23.N0. OF CATCH BASINS 24. NO. OF FLOOR DRAINS 25. NO. OF OTHER FIXTURES ! KIND F /- 26. ARE TOILET COMPARTMENTS VENTILATED TO OUTER AIR BY A WINDOW? �s 27. SIZE OF WINDOW 28. IF NO WINDOW,WHAT KIND OF VENTILATION IS THERE? %--------� 29. SIZE OF DUCTS 30. ARE SEWAGE AND WATER FACILITIES AVAILABLE? y� SIGNATURE ADDRESS O AIA U�-Z,7'- �/4 �---` p Ctl 9' LICENSE NO. afO� ESTIMATED COST 5 ✓�00, D ® TELEPHONE OWNER A4411P fA,4 ZER ADDRESS I Y E // - ,7 3yTT4/ PLA�� B4Q!? 1F/"-kJ17 WATER HEATER 31. TYPE FG teEAR Al GF o/L -F/RED 32. MANUFACTURER JEQ. y U-'f TF'lQ #5,4 TEA TANK SAFETY DEVICES 33. CAPACITY .-O e, ,01 i O/�'S' 37. TEMPERATURE RELIEF VALVE o2 /L-19 OF 34. TEST PRESSURE .J ( I .� •� 38. MANUFACTURER_4e-A T rY A FeZ Z.-,.ZA �"OR 35. WORKING PRESSURE I / S� �•� 39. PRESSURE RELIEF VALVE / '-'57O 36. TYPE D/:4 - Fl,&,Fh ��Tf)Q )V T fA 40. MANUFACTURER U--A TITS A E Ic 001. � ALL WORK COVERED BY THIS APPLICATION HAS BEEN AUTHORIZED BY THE OWNER OF THIS PROPERTY AND WILL BE DONE IN STRICT ACCORDANCE WITH THE BUILDING CODE. CD962 DAT SIGNATURE' APPLICANT ' I A PERMIT # Application For c DEPARTMENT DECISION 703� � o Heatmg Permit 3 APPLICATION IS HEREBY: DEPARTMENT OF LICENSES AND INSPECTIONS ❑ APPROVED ❑ DISAPPROVED TOWN OF SOUTH WINDSOR 0 cd O 06 00 DATE CHIEF INSIECTON APPLICATIONS MUST BE PRINTED OR TYPED. BEGIN WITH MURDER ONE DELOW O aD •a gt. LOCATION OF JOB/�l�0 R S K I A IR cd C NO. BTRttT � vv, LOT NO. *COCK APT. NO. N a E s. OWNER S. ADDRESS 1 I S //—/7 sl e T T O I-o� A419 e46 bo g f T. a.NHONEI 9r Z VJ '= S. APPLICANT 'a/yAl D A. D. I/,A/J P .,� B. ADDRESS jSel 7 tx •. LICENSE NO. Q � / D. EXPIRATION DATE OF LICENSE / o '� .8 t 10. ESTIMATED COST S 0• 00 4-) -g E •" t t. IS THIS A CONTRACT COST? � YES ❑ NO O t s. FEE ENCLOSED s1 � v v III. TYPE OF BUILDING: to N NESIDENTIAL ❑ COMMERCIAL be O .R ❑ cc tS. TYPE OF JOB:ORIGINAL ALTERATIO INDUSTRIAL INSTALLATION ❑ ADDITION N REPAIR li94eGr 0' / APPLICATION FOR HEATING PERMIT (Continued it m Reverse Side) 11. LOCATION OF JOB NO. STREET _Fbee ' AFT.N . 12. TYPE OF INSTALLATION: OIL BURNER ❑ ELECTRIC ❑ VENTILATION ❑ SPRINKLER ❑ GAS BURNER ❑ STACK ❑ INCINERATOR ❑ MISCELLANEOUS d y,• IDENTIFY SIZE LOCATION P�A /� SIZE /� SIZE 13. OF TANK 0 d OF TANK /O F f R OH ,8y/.L l�/�G OF FILL OF VENT 14. B.T.U. EQUIP. AT REGISTER F URry25F MAKE AND NO. AT BONNET FIRING RATE BOILER AND NO. AILA B.T.U. OR SO. FT. NETLEgus-20B.T.U. OR SO. FT. GROSS,/��IRING RATE LS FLOORS TO BE HEATED NEW OR OLD BUILDING INSULATED - YES OR NO rES1' TYPE OF WALL-X-_4;�: INS LATION C-'-ROOF OR CEILING X 8 INSULATION G le.-*AVG. SYSTEM WATER TEMP. ` aD B.T.U./91*WRb.'/HR. EMISSION �O© ©Z:4::., f-" .40=-Ic4F INDOOR,QUTDOOR TEMPERATURE DIFFERENCE. dp O 0.FAHRENHEIT MAKE OF RADIATION: BASEBOARD. COPPER CONVECTORS. OR C.I. RADIATION. OUTPUT PER SECTION OR LINEAL OF RADIATION. SQ. FT. OR B.T.U. s,&,,(,T',E' e-G40 DESCRIPTION OF WORK IS. TO BE DONE: yEA�/�� �'J'�TEf>' /1�.S�Zi9d,ak,4T/ON �/yleOl��HOI�? ycoL OO/Q S w//o o� SAG y�D�� ��O y�1� o/.L T4 1--,00k 16. HEAT LOSS SCHEDULE. (TO BE INCLUDED FOR ALL JOBS): ' ROOM SIZE WINDOWS AREA — SQUARE FEET s.T.U. s.r.U. F O AND DOORS VOLUME t I- DISTRIBUTION INSTALLED NO- ` TOTAL TOTAL p/�oL ROOM L W N AND GROS! GLASS NET WALL CEILING FLOOR CU.FT. AT 70•P CONNECTED t j r p/7JG RAD. REGISTER WALL t0 (INFILT.) TEMP. TO f; O TYPE AND>lTIZE OR LEAOER SIZE f'G DIFF. 8° •F 30. IT. FREE AREA �Ap Fr .• `/ o . o Q TU O A 0 51 Dl7Y 17 ,1A00 x S / 132 2' 00 ,FP roe R �s 8 8 °O s s 711 BATH !Z s ° yo ° 05r /osz' 3 X_r Joe 9100 /C5 02.2 yj Ig - ° 1 S .2s88 ° ° TAD 11 z 8 TOTALS A. HEAT LOSS FROM BUILDING B.T.U./HR. B. DOMESTIC HOT WATER DEMAND B.T.U./HR. C. PIPING. OTHER THAN NORMAL B.T.U./HR. ALLOWANCE FOR HEAT VALVE OF FUEL (A B C) FACTOR 17. ELECTRICAL WORK BY: ,.�IARk FAA lA PE ' F,L �TR/C, l/0 EAST/SCAR 0.4 D S'T Bl004fi�07.�y� NAME ADDRESS SUBCONTRACTORS AND 16. THEIR TRADES ALL WORK COVERED BY THIS APPLICATION HAS BEEN AUTHORIZED BY THE (OWNER) OR (AGENT) OF THIS PROPERTY AND WILL BE DONE IN STRICT ACCORDANCE WITH THE BUILD G ODE. APPLICATION TO BE COMPLETELY FILLED IN. 7 /_ DATE SIGNATURE OF APPLICANT PERMIT # • Application For x DEPARTMENT DECISION Heating Permit 0 it APPLICATION IS HERESY: DEPARTMENT OF LICENSES AND INSPECTIONS ❑ APPROVED ❑ DISAPPROVED TOWN OF SOUTH WINDSOR w co o p, 00 n► DATE CHIEF INSPECTOR APPLICATIONS MAST BE PRINTED OR TYPED. BEGIN WITH NUMBER HE BELOW M � -� 1. LOCATION OF JOB .r 0 .� Ij NO. STREET • e�i LOT NO. FLOOR AFT. NO. O . OWNER s~ 0 S. ADDRESS ._ 4.PHONE � a f� ,C I. APPUCANT G. ADDRESS T.PHONE G. LICENSE NO. CL w D. EXPIRATION DATE OF LICENSE 0p 10. ESTIMATED COST N Is THIS A CONTRACT COS" ❑ YEs ❑ NO v be 1!. FEE ENCLOSED s .o v d 19. TYPE OF BUILDING: RESIDENT" ❑ COMMERCIAL +' 14. TYPE F JOB: INDUSTRIA' t �+ ORIGINAL ALTERATIi INSTALLATION ❑ AOOITIVV' REPAIR /Uel:" --;�"2 APPLICATION FOR HEATING PERMIT (C atinuea from Rev roe Side) i 1. LOCATION OF JOB W, O TA'/3 A a- /// �O,Q���' A!Q , �/o e.,Ste' II'0. STREET _rmn A►T.N . 11. TYPE OF INSTALLATION: OIL BURNER ❑ ELECTRIC ❑ VENTILATION ❑ SPRINKLER ❑ GAS BURNER ❑ STACK ❑ INCINERATOR ❑ MISCELLANEOUS IDENTIFY SIZE LOCATION SIZE SIZE 1& OF TANK OF TANK OF FILL OF VENT 14. B.T.U. EQUIP. AT REGISTER FURNACE MAKE AND NO. AT BONNET FIRING RATE BOILER OR FURNACE MAKE AND NO. B.T.U. OR SO. FT. NET B.T.U. OR SO. FT. GROSS FIRING RATE FLOORS TO BE HEATED NEW OR OLD BUILDING INSULATED - YES OR NO TYPE OF WALL INSULATION ROOF OR CEILING INSULATION AVG. SYSTEM WATER TEMP. B.T.U./SQ. FT./HR. EMISSION INDOOR-OUTDOOR TEMPERATURE DIFFERENCE "FAHRENHEIT MAKE OF RADIATION: BASEBOARD. COPPER CONVECTORS. OR C.I. RADIATION. OUTPUT PER SECTION OR LINEAL OF RADIATION. SO. FT. OR B.T.U. DESCRIPTION OF WORK 1S. TO BE D HE 16. HEAT LOSS SCHEDULE. (TO BE INCLUDED FOR ALL JOBS): wool i1sE AREA v SQUARE FEET ��� ••T U. V. �•T. AMC COORS C TOTAL TOTAL DISTRIBUTION INSTALLED r � w OY No. opI GLASS NET WALL CEILING FLOOR CU. AT 7D•orww CoECTim J REGISTER L W N AMC `3 TEMP. To L T�/ !AMC SI E RAG. R LEADER SIZE < WALL t0 (IN/ILT.) OIFF. 8 Q •F I-m M OO BTv SO. FT. FREE AREA A���. o c � 1 sc ylc .?•3 EAT 14,O Lis 1 A t,EATH ISM TOTALS /0 1 1 102 p A. HEAT LOSS FROM BUILDING d B.T.U./HR. �� ���• FT e B. DOMESTIC HOT WATER DEMAND D e B.T.U./HR. C. PIPING. OTHER THAN NORMAL '�-' B.T.U./HR. ALLOWANCE FOR HEAT VALVE OF FUEL (A B C) FACTOR 17. ELECTRICAL WORK BY: NANE ADDRESS SUBCONTRACTORS AND is. THEIR TRADES ALL WORK COVERED BY THIS APPLICATION HAS BEEN AUTHORIZED BY THE (OWNER) OR (AGENT) Of THIS PROPERTY AND WILL BE DONE IN STRICT ACCORDANCE WITH THE BUILDING CODE. APPLICATION TO BE COMPLETELY FILLED IN. HOME OCCUPATION FORM Qd�✓� Minor V ZEO Approval Date Q ASSESSOR'S USE ONLY: Major. PZC Approval Date Home Occupation Type Expiration Date Code PM ctu Lb nos Name J Address of proposed occupation: tit O(� ,1 r I 11P Telephone O Z��' ���) Zone Description of Occupation: _ Sookwark -cow keolft4ckv b�rJ�o� ou�r���,�w sh4�r�� •�Q/ all,n o ale tfz- a PROPOSED SIGN Please use the boxes or an attached sheet to provide the following: 1. Attach copy of plot plan if applicable. V/4 Use box A(or attach sketch)to draw proposed signage. N/A 3. Use box B (or attach sketch)to draw the floor plan of the home "Af occupation area v4! Architectural elevations for any proposed additions or modifications must be provided. B. FLOOR PLAN( Basement 1st Floor ✓ 2nd Floor) Floor area of dwellings Floor area of home occu ation S F %of floor area • ry �a I have read the regulations regarding home occupations and intend to comply with said regulations. I understand I must notify the Planning DepartZ,"i n 'ting u teiminaton of this 'on at this address• Signature of ApplicantDate Signature of Home Owner / r ` / ate (� White = Assessor Yellow = Applicant Pink — Street File HOME OCCUPATION FORM Minor. ZEO Approval Dace'%� 1 e J ASSESSOR'S USE ONLY: Major PZC Approval Date Home Occupation Type Expiration Date Code Name -Tu I t an is Address of proposed occupation: F)0 rS LA Telephone a 13.)- — I U Zone Description of Occupation: prov( dwn a <,er)a Uof ro o k�l n —el h(1 12 a Lh I g2l 1�In a M SJIM CC' 4 341 be e., S. S11G N 3 tTP► JA,1--S r► ��' b\sr, A PROPOSM SIGN Please use the boxes or an attached sheet to provide the following: 1. Attach copy of plot plan if applicable. 2. Use box A (or attach sketch)to draw proposed signage . 3. Use box B (or attach sketch) to draw the floor plan of the home occupation area. 4. Architectural elevations for any proposed additions or modifications must be provided. B. FLOOR PLAN ( Basement 1st floor t✓ 2nd Floor) Floor area of dwelling &)0 Floor area of home occupation 1 y4 sq 14. % of floor area g° o 1 2-J � zl I have read the regulations regarding home occupations and intend to comply with said regulations. I understand I must notify the Planning Department in writing upon termination of this occupation at this address. Signature of Applicant Date A y o Signature of Owner Date AQv White = Assessor Yellow = Applicant Pink = Street File