1

CITY OF ADRIAN Labe Building Permit Permit No: PB12-092

Construction Code Services 135 E . MAUMEE ST ADRIAN, Ml. 49221
Phone: 517-264-4814 Fax:~15i1-~t:B8 Hours: Monday-Friday 8 am - 4:30 pm

Owner:
1365 E BEECHER ST
BEECHER ASSOCIATES I
XA0-61 0-0001-00 Zoned 938 DURSLEY RD
BLOOMFIELD HILLS Ml 48304-2012
Contractor (490) 543 4563
Occupant:
K & D DEMOLITION & EXCAVATING BEECHER ASSOCIATES I
16016 MESSENGER RD 938 DURSLEY RD
BURTON OH 44021 BLOOMFIELD HILLS Ml 48304-2012

Applicable Cock: Michigan Code 2009 Issued: 04/30/12 Expire Date: 10/27/12

Work Description: Dura Demolition of factory portion of building , leaving office section for new business site.

Stipulations: PLEASE HAVE PERMIT AND PLAN ON SITE FOR ALL INSPEC110NS

- - -- - - -- - -- - -
Permit Item Work Type Fee Basis Item Total
All work not involving sq ft 6) Build Permit 1.00 $0.00
Demolition Build Permit 1.00 $0.00

Fee Total: $0.00

Dick Garno, Building Inspector Amount Paid: $0.00
·- · --··-
Authorized by Balance Due: $0.00
I agree lh is pe rmit is only fo r the work described, and docs n ot grant per mission for addit ional o r related work which requires separat e perm its. I un derst an d
that t his perm it will exp ire, an d become null and vo id if work is no t started wit hin 180 days, or if work is suspe nded or abandoned for a perio d of 180 days
at an y t ime aft er work has commenced; an d, th at I am responsible fo r assuring a ll required inspections are requested in co nform ance with the applicable co de
I hereby certify that the proposed work is authorized by the own er, and th at I am autho rized by the owner to make th is application as h is auth orized agent.
I agree to con fo rm to all applicable laws of the State of Michigan and the local j urisdiction. All informa tion on the p erm it app lication is accurate to the bes
of my knowledge
Payment of pennit fee constitutes accep1ance of the above terms.

POST THIS PERMIT SO IT IS VISIBLE FROM THE STREET

PLEASE CALL FOR THESE REQUIRED INSPECTIONS
D Footing D Frame
- ----
D Insulation D Mobile Home Installation

~· ~:::-~:~~~c~;ancy
0 ~~nc~~te Sla_b_ 0 Structural Steel 0 Open Roof

D Backfill D
CONTRACTORS ARE RESPONSIBLE FOR SCHEDULING INSPECTIONS.
THIS IS IN ACCORDANCE WITH STATE CODES.
PLEASE CALL 264-4814 TO SCHEDULE INSPECTIONS. THANK YOU.
PLEASE ALLOW 24 HOURS NOTICE FOR A PPOINTMENTS.
 BUILDING PERMIT APPLICATION
City of Adrian
Paid
Construction Code Services
135 East Maumee Street
OFFICE USE ONLY
Adrian , Mi 4922 1
Ph. 517-264-4814- Fax 517-264-80 16
Download applications at www.ci. adrian.mi. us

I. PROJECT INFORMATION
of Project:
t_,>(fr -
11. OWNER OR LEASSEE
Nam~
·s 2- ~Gz.S.T

Contact Name Company

City State Zip Telephone Number

License Number Expiration Date

Office Ph/f ·

Daytime I Cell Phone: ~ . l f1r l _

:;l I & __. -::J 7 ... 'f ~ V7

Not Licensed

**Please attach co an Builder's License if not alread on file.

General Contractor Sub-Contractor
Federal Employer ID Number or Reason for Exemption:

Worker's Comp Insurance Carrier or Reason for Exemption:

MESC Employer Number or Reason for Exemption :

Ill. TYPE OF IMPROVEMENT AND/OR PLAN REVIEW

New Construction New Addition Alteration Repair Only Relocation

Deck D Ramp Porch D Roof Garage Carport In-Ground Pool
Manufactured Mobile Home Foundation Only Above-Ground Pool
Demolition I Have Utility Companies been contacted? Date Contacted :
 l
IV. PROPOSED USE OF BUILDING
A. Residential
LJ1. One-Family LJ 3. Hotel, Motel LJ 5. Detached Garage
Number of Units
0 2. Two or more Family 0 4. Attached Garage Other 0 6.
Number of Units
B. Non-Residential
..__
-
7. Amusement
8. Church Religion --
11. Service Station
12. Hospital, Institutional
- 15.
- 16.
School, Library, Educational
Store, Mercantile

- 9. Industrial
10. Parkinq Garage
..___ 13. Office, Bank,
14. Public Utility
Professional 17. Tanks, Towers
18. Other -
Non-Residential - Describe in detail proposed use of building. Such as: food processing plant. machine shop, laundry
building at hospital, elementary school. secondary school, college, parochial school, parking garage for department store,
rental office building , office building at industrial plant. If use of existing building is being changed, enter proposed use.

Q,(,L;.A, 1{J CJl[p ~~f(

CN~

V. SELECTED CHARACTERISTICS OF BUILDING

A. Principal Type of Frame (Please Circle) ~,,,,:.---
1. Masonry, Wall Bearing j 2. Wood Frame { """
Structu~. " Reinforced Concrete j s. Other
B. ~ipal Type of Heating Fuel (Please Circle)
/~ Ga3' 1 J 7. Oil 8. Electricity J 9. Coal J 10. Other
__. __ Jr-
~y,nA I~ -1 (Please Circle
"
vcn ... M·- -

~ Public~
. .;, -•- ~
__ •• 1-1a1. 1~, 12. Septic System
D. Type of .. .....-.::: .. ..: ....... nh.r <Please Circle)
~ublic or Private Compghy 14. Private Well or Cistern
c. I Yr-v v; :.~ ....... amcal (Please Circle)
15. Will there be Air Conditioninq? Yes No 16. W ill there be Fire Suooression? Yes No
F. Dimensions I Data
21. Floor Area Existing Alteratioos New
17. Number of Stories

18. Use Group

l Basement

First & Second Floor

19 Construction Type P~te ~w Third - Tenth Floor

20. No. of Occupants Eleventh - Above

Total A rea
G. Number of Off-Street Parking Spaces
22. Enclosed 23. Outdoors
VI. Applicant Information
APPLICANT IS RESPONSIBLE FOR THE PAYMENT OF ALL FEES AND CHARGES APPLICABLE TO THIS
APPLICATION AND MUST PROVIDE THE FOLLOWING INFORMATION:

L/tl.J, f7~_!l.
NAME

~(}_ CA_:;; <;'T l~r ;;;;.

l hfMRU!f/
STATEL Z IP CODE TELEPHONE NUMBER (include a:ea cod~)
Cl~M~t/u F ·~-f31q
1

~~ :-ft,~3~ o~ x~
f
r
I

FEDE~ ~L~?
s~~J~O" tor exemption)
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 APPLICATION AS HIS/HER AUTHORIZED AGENT,
AND WE AGREE TO CONFORM TO ALL APPLICABLE LAWS OF THE STATE OF MICHIGAN. ALL INFORMATION
SUBMITIED ON THIS APPLICATION JS ACCURATE TO THE BEST OF MY KNOWLEDGE.
Section 23a of the State Construction Code Act of 1972, 1972 PA 230, MCL 125.1523a, prohibits a person
from conspiring to circumvent the licensing requirements of this State relating to persons
who a:..:~~ on a residential building or a residential structure.
10 of Section...23a are subjected to civil fines.

Signature of Applicant~ /~I ~ - /laL~

Building Permit Fee Enclos~ J v
/ /
(The first $75.00 of an application is Non-refundable (included $50.00 Certificate of Occupancy fee)
VII. Local Governmental Aaency to Complete This Section
ENVIRONMENTAL CONTROL APPROVALS
Reg uired? Aeeroved Date Number fu:

A-Zoning Yes No
B - Fire Dept. Yes No
C - Pollution Control Yes No
D - Noise Control Yes No
E - Soil Erosion Yes No
F - Flood Zone Yes No
G - Water Supply Yes No
H - Septic System Yes No
I - Variance Granted Yes No
J - Other Yes No

VIII. Validation - For Department Use Only

Use Group
F-J Application Fee (non-refundable

Type of Construction 2 - ,5 Number of Inspections

~
Square Feet

~;/ ../!J~
Approval Signature

Title
BiML~~ IDate 'I - 2 7,. 12
u 7J