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, 13inPartD. 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, 13z.
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 Approvalova
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,