1 LANGDON STREET - BUILDING INSPECTION I i ANGDON STREET
/S 0 33 6
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APPLICATION FOR
PLAN EXAMINATION AND
BUILDING PERMIT
IMPORTANT — Applicant to complete all items in sections: 1, 11, /it, IV, and IX. O
/�,� ZONING
1. AT (LOCATION) �, 1�T\ S- DISTRICT
LOCATION (NO.) (STREET)
OF BETWEEN AND
BUILDING (CROSS STREET) (CROSS STREET)
LOT
SUBDIVISION LOT BLOCK SIZE
II. TYPE AND COST OF BUILDING - Ali applicants complete Parts A - D 1
a
A. TYPE OF IMPROVEMENT D. PROPOSED USE — For"Wrecking" most recent use rn
M
-r
1 New building Residential Nonresidential
2 ❑ Addition(It residential, enter number 12& One family 18 ❑ Amusement, recreational
of new housing units added, if any,
in Part D, 13) 13❑ Two or more family — Enter 19 ❑ Church, other religious
number of units— — — — -- 20 ❑ Industrial
3 ] Alteration (See 2 above) 14 ❑ Transient hotel, motel,
4 ❑ Repair, replacement or dormitory — Enter number 21 Parking garage
5 ❑ Wrecking ([f multifamily residential, " of units ------- — y 22 ❑ Service station, repair garage
enter number of units in building in 15 ❑ Garage 23 ❑ Hospital, institutional
Part D, 13)
6 ❑ Moving (relocation)
16 ❑ Carport 24❑ Office, bank, professional
7 ❑ Foundation only 17 [7Other — Specify 25[:] Public utility
26 ❑ School, library, other educational
B. OWNERSHIP 27 ❑ Stores, mercantile
8 JW Private (individual, corporation, 28 ❑ Tanks, towers
nonprofit institution, etc.) 29 ❑ Other — Specify
—
9 ❑ Public (Federal, State, or
local government)
C. COST (Omit cents) Nonresidential — Describe in detail proposed use of buildings, e.g.,. food
processing plant, mac.iine shop, laundry building at hospital, elementary
10. Cost of improvement,,,,•,,,,,,,,,,, school, secondary school, college, parochial school, parking garage 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 a�
a. Electrical....................... 2-3oo
b. Plumbing ....................... N..W
c. Heating, air conditioning..........
d. Other(elevator, etc.).............
11. TOTAL COST OF IMPROVEMENT
III. SELECTED CHARACTERISTICS OF BUILDING - For new buildings and additions, complete Parts E - L;
for wrecking, complete only Part J, for all others skip to IV.
E. PRINCIPAL TYPE OF FRAME G. TYPE OF SEWAGE DISPOSAL J. DIMENSIONS
30 Masonry (wall bearing) 40 Public or private company
48. Number of stories.............
31 Wood frame 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 ❑ 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 1. TYPE OF MECHANICAL 51. Enclosed .......................
35 ❑ Gas Will there be central air 52. Outdoors........................ �
36 JK Oil conditioning?
.L. RESIDENTIAL BUILDINGS ONLY 13
37 ❑ Electricity 44 ❑ Yes 45 nNo 53. Number of bedrooms..............
38 ❑ Cool
39 ❑ Other — Specify. Will there be an elevator? Full.......... f
54. Number of
46 ❑ Yes 47 n No bathrooms
Partial........
NOTES and Data — (For department use)
IV?IDE`fTIFICATION — To be completed by all applicants
Name Mailing address — Numbrr, streel, city, and Slate ZIP code Tel. No.
rZOwner or
Lessee
2. bBain ers
niLicense No.
Contractor I
3.
Architect or,
Engineer
I I hereby certify that the proposed work is authorized by the owner of record and that I have been authorized by the owner to
make this apps his authorized agent and we agree to conform to all applicable laws of this jurisdiction.
ignatur71l Address =�7�
date
� o X 86 �
r•� DO NOT WRITE BELOW THIS LINE
V. PLAN REVIEW RECORD — For office use
Plans Review Required Check Plan Review Date PlansB Date Plans B Notes
Fee Started y Approved y
BUILDING $
PLUMBING $
MECHANICAL $
ELECTRICAL $
OTHER $
VI. ADDITIONAL PERMITS REQUIRED OR OTHER JURISDICTION APPROVALS
Permit or Approval Check Date Number B y Permit or A ol Check Date Number B
Obtained ppryaObtained y
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
Building / is-
Building
FOR DEPARTMENT USE ONLY
Permit number 6 /
Building Use Group
Permit issued 19
Building VFire Grading
Permit Fee $ ]//-
Live Loading
Certificate of Occupancy $ Occupancy Load
Approved by:
Drain Tile $ 11,01-4
Plan Review Fee
$ ^ `�
V
4 TITLE
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