HomeMy WebLinkAbout16 Brian Road (2) TO THE BU11ADING INSPECTOR
of etc APPLICATION FOR
'!" OF MUM wMakesm COAL PLAN EXAMINATION AND
BUILDING PERMIT
IMMRTAff— Applicant to complete all items in Sections: 1, It, Ill, IV, and IX.
1 AT (LOCATION) �6 An ey ZONING
LOCATION 1 (Me•)// (sTRttT) DISTRICT
OF BETWEEN 61<::z AMC WCT)r /
BUILDING (CROSS STRCET) (CROSS sT1199T)
LAT
SUOCIVISION LOT 00-OCK SIZE
11. TYPE AND COST OF BUILDING — All applicants complete Ports A — D
A. TYPE OF IMPROVEMENT 0. PROPOSED USE - For"Wrecking" most nsce"use
1 ❑ Now building Residential Nonresidential
2❑ Addition(lf residential. enter awnbe► 12❑ One family 18 El Amusement, recreational
of near bo usi as writs added. it any.
is Part D. 13) 13❑ Two or more family - Enter 19❑ Church, other religious
number of units- - � Industrial
3 CD Alteration (See ? above) �14❑ Transient hotel, metal, ❑
4❑ Repair, replacement 21 ❑ Perking verve
or dormitory - Eater number
5❑ Wrecking (It multifa ily residential. of units ------- -- 22❑ Service station, r peir gene
eater number of writs in building in 15❑ Geroge 23❑ Hospital, institutional
Part D. 13)
❑ 16 export p �d�D�c� 24❑ Office, bank, professional �
6 Moving (relocation) 17 that Specify 25❑ Public utility
7 C( F undation only 26❑ School, libre
y ,/ ry, other educational
e. OWNE SHIP n / /7`�`� 27❑ Stores, morcontiIs
6 �Privete(individual, corporation, 28❑ Tanks, towers
to nprefit institution, etc.) 29❑ Other - Specify
9 ❑ Public (Federal, State, or
eel government)
C. COST (Omrt cents) Nonresidential - Describe in detail proposed use of buildings, .g., fo d
processing plant, machine shop, laundry building at hospital, lomentery
10. Cost of improvement...�Q,Q�,Cy�,, school, socondery school, college, porochial'schaol, parking lore"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 o. Eleetrocel...................... 0 X
b. Plumbing ......................
c.Meeting, air conditioning.........
d. Other(elevator, oft.)............. `
1 11. TOTALCOST OF IMPROVEMENT 00 . c7
III. SELECTED CHARACTERISTICS OF BUILDING — For new buildings and additions, complete Ports E — L;
for wrecking, complete only Port J, for all others skip t IV.
E. PRINCIPAL TYPE OF FRAME G. TYPE OF SEWAGE DISPOSAL J. DIMENSIONS
30 n Masonry(well bearing) 40❑ Public or private company 46• Number of stories................
31 ❑ Wend freme 41 ❑ Private(septic tank, etc.) 49• Total square feet of floor area,
all floors, based on exterior
32❑ Structural steel dimensions .....................
33 Unforced concrete H. TYPE OF WATER SUPPLY
34 Other - Specify 42❑ Public or 50. Total land area, sq. ft. ...........
p /y private company
43 ❑ Private(well, cistern) K. NUMBER OF OFF-STREET
PARKING SPACES
F. PRINCIPAL TYPE OF HEATING FUEL 1. TYPE OF MECHANICAL 51. Enclosed .......................
35❑ Gas Will then be central air 52. Outdoors.......................
38❑ Oil conditioning? L. RESIDENTIAL BUILDINGS ONLY
37❑ Elesttieity 44❑ Y s 45❑ No 33. Number of bedrooms. ..........
38❑ Coal
39❑ Other- Specify Will th to be on elevator?
54. Number of Full..........
46❑ Yes 47❑ No bethreems Partial........
IV. IDENTIFICATION — To be comp) ted by all applicants
ZIP cod T I. No.
Naive Mailing eddr ss — Number. street. city. and State
Owner o►
Lessee ,i a G,,,�1 Zb'7
2. o6 F1Z Qa'►�S1��1 v O 7
Cantrac•or
3.
Architect or
Engineer
The own r of this building and the undorsigned agree to conform to all applicable laws of this jurisdiction. Apple tion date
Address „/f / ,'P1��G� 117
S�gnatur of applicant � /O� //�// �/ W
00 NOT WRITE BELOW THIS LINE
EPIans
REVIEW RECORD — For office use Dote Plans
Check PIO^ Review D Startedate By By Approved BY Notes
ev. w Required Fee
BUILDING
PLUMBING
MECHANICAL S — -- — —J
ELECTRICAL
OTHr_R -VI. ADDITIONAL PERMITS REQUIRED OR OTHER JURISDICTION APPROVALS pate ! 94umber g�
Dote Number BY Permit or Approval Checkl Obtained
Permit or Approval Check Obtained
PLUMBING
BOILER ROOFING
CURB OR SIDEWALK CUT SEWER
ELEVATOR SIGN OR BILLBOARD
ELECTRICAL
STREET GRADES
FURNACE USE OF PUBLIC AREAS
GRADING WRECKING
OIL BURNER OTHER
OTHER
VII. VALIDATION
Building
P rmit number
Bui Iding Z z, 19 �1
Permit 1ssu d D
Building / Vi
Permit Fe S e
Approv d by:
TITLE