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)
LATSUOCIVISIONLOT00-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, recreationalofnearbousiaswritsadded. it any.
is Part D. 13) 13 Two or more family - Enter 19 Church, other religious
number of units- - Industrial3CDAlteration (See ? above)
14 Transient hotel, metal, 4 Repair, replacement 21 Perking verveordormitory - 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, institutionalPartD. 13)
16 export
p d D c
24 Office, bank, professional6Moving (relocation)
17 that Specify 25 Public utility7C( 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.).............
111. 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 exterior32 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 ONLY37 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 117Sgnaturofapplicant
O //// /
W
00 NOT WRITE BELOW THIS LINE
EPIans REVIEW RECORD — For office use
Dote Plans
Check
PIO^ Review D Startedate ByBy 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
DBuildingVi
Permit Fe S e
Approv d by:
TITLE