HomeMy WebLinkAbout12 Betty Drive (6)To THE BUILDING INSPECTOR
of 1w APPLICATION FOR
OWN OF COW PLAN EXAMINATION AND
BUILDING PERMIT
IMPORTANT— Applicant to complete all items in sections: 1, It, III, IV, and IX.
1. ZONING
AT (LOCATION) DISTRICT
LOCATION mo.) STREET)
OF BETWEEN AND
BUILDING CROSS STREET) CROSS STREET)
LOT
SUBDIVISION LOT BLOCK SIZE
II. TYPE AND COST OF BUILDING — All applicants complete Ports A — D
A. TYPE OF IMPROVEMENT D. PROPOSED USE - For•'wrecking'• most recent use
1 N w building Residential Nonresidential
2 Addition(lf resident:al, eater nwnber 12*Z On* family 18 Amusement, recreati nal
in Past D. 13) Two or more family - Enter 19 Church, other r ligi usnewhousingunitsadded. if any,
in 13
3
number Of units- - -
Alt ration (See 2 above)
20 Industrial
14 Transient hotel, motel, 21 Perking garage4 Repair, replacement or dormitory - Enter number
5 Wrecking (i/multifamily residential. of units ------- -- 22 Service station, repair garage
enter number of units :n building in T5 Garage 23 Hospital, instituti nal
Part D. 13)
16 Carport 24 Office, bank, prof ssional
6 M wins (relocation)
17 Other - Specify 25 Public utility
7 Foundation only 26 School, library, other educational
B. OWNERSHIP 27 States, mereanti
9 Private(individual, corporation, 28 Tanks, towers
n np fit institution,etc.) 29 Other - Specify
9 U Public(Federal, State, or
cal government)
C. COST Omit cents) Nonresidential - Describe in detail proposed use of buildings, e.g., fo d
processing plant, machine shop, laundry building of hospital, el m ntery
10. Cost of improvement,,,,,,,,,,,,,,,, school, secondary school, college, parochial-school, parking garage for
department store, rental office building, office building of 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.Hosting, air conditioning.........
d. Other(elevator, etc.)............
11. TOTAL COST OF IMPROVEMENT v
III. SELECTED CHARACTERISTICS OF BUILDING — For new buildings and additions, complete Parts 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
J3QL
1 Meg tfry(wall bearing) 40[g Public or private company
46. Number of stories................
31 Wood from 41 Private(septic tank, etc.) 49- Total square feet of floor area,
all floors, based on exterior
32 Structural steel dimensions ....................
33 Reinforced concrete H. TYPE OF WATER SUPPLY
34 0 Other - Specify 42 Public or private company
50. Total land area, sq. ft. ...........
43 Private(well, cistern) K. NUMBER OF OFF-STREET
PARKING SPACES
F. PRINCIPAL TYPE OF HEATING FUEL I. TYPE OF MECHANICAL
51- Enclosed .......................
35 Gae Will there be central air 52. Outdoors.......................
n Oil conditioning?L. RESIDENTIAL BUILDINGS ONLY
37 EI ctricity 44 Yes 45 N 53. Number f bedrooms.
38 Coal
39 Other- Specify Will then be on el vetw?
54. Number of
Full..........
46 Yes 47 0 He bath eons
Partial........
i
IV. IDENTIFICATION — To b c mpl t d by all applicants
Nam Meiling eddr ss — Number, street, city, and State ZIP code Tel. No.
ca A ffb?&-bY79IOwneroryLesseecktjt/
l
r I
i2.
Controc•or
Architect or
Engineer
The own r of this building and the undersigned agree to conform to all applicable laws of this jurisdiction.
Signatur of applicant Address Application date
00 NOT WRITE BELOW THIS LINE
V. PLAN REVIEW RECORD — For office use
Plans Revi w Required Check Plan Review Date Plans By Date Plans By NotesFeeStartedApproved
BUILDING
PLUMBING
MECHANICAL S
ELECTRICAL
OTHER I is L
VI. ADDITIONAL PERMITS REQUIRED OR OTHER JURISDICTION APPROVALS
Do to tPermitorApprvaICheckObtainedNumberByPermitorApprovalCheck' Obtained Numb r By
BOILER PLUMBING
CURB OR SIDEWALK CUT ROOFING j
ELEVATOR SEWER
ELECTRICAL SIGN OR BILLBOARD
FURNACE STREET GRADES
GRADING USE OF PUBLIC AREAS t
OIL BURNER WRECKING
OTHER OTHER
VII. VALIDATION
Building
Permit numb r
Building
19Permitissued
Building
Permit Fe S
Approved by:
rp
V
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