HomeMy WebLinkAbout15 Blueberry Circle (11) TO THE BUIOLDING INSPECTOR
of do APPLICATION FOR
'DOWN OF SOII'l'H C=W PLAN EXAMINATION AND
BUILDING PERMIT
IMPORTAHT — Applicant to complete oil items in sections: 1, It, III, IV, and IX.
ZONING
I• AT (LOCATION) OISTRICT��
LOCATION � lN0'1 (STREti
OF METWEEN __ -H.,P Q `i``,, --
BUILDING (CROSS STRtET) (CROSS STRtET)
LOT
SUMIVISION LOT •LOCK SIZE
11. TYPE AND COST OF BUILDING — All applicants complete Parts A — D
A. TYPE OF IMPROVEMENT D. PROPOSED USE — For"Wrecking" most recent use
1 ❑ New building Residiontial Nonresidential
2;Z Addition(If residential. truer momber 12 One family 1a❑ Amusement, recreational
o/ retie housing units added. i/arty, 13❑
in Part D. l 3) Two or more femnily — Enter 19❑ Church, other religious
number Of units— — — — —►_— 20❑ Industrial
3 ❑ Alteration (Set 2 above! 14 Transient hotel, metal,
4❑ Repair, r pleeament ❑ or dormitory — Eater number21 ❑ Perking garage
5 ❑ Wrecking (1/mst[ti/aReily residential. of units ——————— ——► �— 220 Service station, repair genga
enter nomber o/rants ere building in is❑ Gore" 23 ❑ Hospital, institutional
Part D. 13) 16❑ Carport 24❑ Office, bank, prof ssionel
6 ❑ M ving (relocation) 17® Other — Specify 23❑ Public utility
771 F undetion only T—` 26❑ School, library, ther-edueationel
B. OWNERSHIP 27❑ Stores, moreantiI*
8 Private(individual, corporation, oo 28❑ Tanks, towers
n nor fit institution, etc.) 29❑ Other — Specify
g ❑ Public(Federal, State, at J f� s G `44t�l�-��`_
eel government) (� �7
C. COST (Omit Cents) Nonresidential — Doseribe in detail proposed use of buildings, e.g., food
processing plant, mechine shop, laundry building of hospital, elementary
10. Cost f improvement............... ,60 school, secondery school, college, perechial'scheol, parking garage for
dopertment store, rental office building, office building at industrial plant.
T be installed but not included If use of existing building is being changed, enter proposed us .
in the above cost
a. Electrical......................
b. Plumbing ......................
c.Meeting, air conditioning.........
d. Other(eleveter, etc.)............ r L
11. TOTALCOST OF IMPROVEMENT (3 60
III. SELECTED CHARACTERISTICS OF BUILDING — For new buildings and additions, complete Parts E — L;
for wrecking, complete only Part J, for all others skip t 1V.
E. PRINCIPAL TYPE OF FRAME G. TYPE OF SEWAGE DISPOSAL J. DIMENSIONS
30`J Masonry(well bowing) 40❑ Public or private company 40• Number of stories................
31 ❑ Wood frame 41 ❑ Private(septic tank, etc.) 49• Total square foot of floor tree,
all floors, based on exterior
32❑ Structural steal dimensions ....................
33❑ Reinforced concrete H. TYPE OF WATER SUPPLY
❑ Other — Specify 42❑ Public or private company
50. Total land woo, sq. ft. ...........
34
430 Private(wall, cistern) K. NUMBER OF OFF-STREET
PARKING SPACES
51. Enclosed ......................
P. PRINCIPAL TYPE OF HEATING FUEL I. TYPE OF MECHANICAL
35❑ Gas Will there be central air 52. Outdoors.......................
3B❑ Oil conditioning? L. RESIDENTIAL BUILDINGS ONLY
37❑ El ctricity 44❑ Yes 45❑ No 53. Number f bedrooms..............
3a❑ Coal
39❑ Other— specify Will there be on lovater? 54. Number of Full..........
46❑ Yes 47❑ N wtt+reews
Partial........
IV. IDENTIFICATION — To be comp) ted by all applicants
Name Mailing addr ss — Number, street, city, and State ZIP cod Tel. No.
Own r or __, /{nI^(C �•.(l��
I � �e,n�,Mc�('Q, �� 13
z. �
Contrac•or 78 9-756
3.
Architect or
Engine r
Th owner f this building and the undersigned agree to conform to all applicable laws of this jurisdiction.
Sign ur of applicant Address Application date
ti
/ IDAl� a
00 NOT WRITE BELOW THIS LINE
V. PLAN REVIEW RECORD — For office use
Plan Review Date Plans Date Plans
Plans Review Required Cheek Fee Started By Approved BY Notes
BUILDING $
PLUMBING $
MECHANICAL S
ELECTRICAL S
OTHER Is
V1. ADDITIONAL PERMITS REQUIRED OR OTHER JURISDICTION APPROVALS
Date Permit or Approval ova Date
Permit or Approval Check Obtained Number By pp l Check) Obtained Numb r 3r
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
Bui Iding //
P rmit number l� 4
Bui Iding
P rmit issu d 19
Building
P rmit Fee S ��
Approved by:
TITLE
• „�'J�/�Slfl T�L..Nc7. �y�'6113�� .�ivU'12�u.�✓v�o�.
INSPECTION REPORT
Permit #/6 406 Job 16—f-3,LUEZE-R(2) ()l2CJ.
1 Footing p YJQL-V St.,SAC.e�J46 S
2 Foundation
3 Framing
4 Wiring /p Q 6a cTfz,IG
5 Plumbing
6 Heating
7 Lathing
a C.O. r 247 z,