8 MESSERVY ST - BUILDING INSPECTION (2) PUBLIC PROPERTY
DEPARTMENT
Kl%rAFJU.EY DRISCOLL
MAYOR 120 WASHINGTON STREET JAI.a:J4.MAssnC}tt;stl'rs 01970
T EL,979-745-9595 •FAX:97S-74o-9s µ
APPLICATION FOR THE REPAIR% RENOVATION CONSTRUCTION
DEMOLITION OR CHANGE OF USE OR OCCUPANCY FOR ANY EXISTING
STRUCTURE OR BUILDING
1.0 SITE INFORMATION
Location Name: C2 U _ Building:
Property Address:
5i�1 / 1A
Property is located in a; Conservation Area Y/N Historic District YIN /1-./_
2.0 OWNERSHIP INFORMATION
2.1 Owner of Land `
Name:
Address: /
Telephone.
3.0 COMPLETE THIS SECTION FOR WORK IN EXISTING BUILDINGS ONLY
Addition Existing
Renovation Number of Stories Renovated
Change in Use New
^ molition existing
Approximate year of Area per floor (sf) Renovated
construction or renovation
of existing building New
Brief Description of Proposed Work:
�evno (�ep )sc� res WAQ
- - -
Mail Permit to:
What is the current use of the Building? &5 ANC!
Material of Building? 1,/�o A If dwelling. how many units?
Will the Building Conform to Law? VBh —
Asbestos?
Architect's Name
Address and Phone —
Mechanic's Name P�6o_✓_ � rq`7 .-7Si OZc�3g
Address and Phone
�yt"OtyC' r/i ��r
,/Construction Supervisors License# CS O4O I q(a IiIC Registration# /09�
Estimated Cost of Project$ c"�) Permit Fee Calculation
Permit Fee$ �a Estimated Cost X$7/$1000 Residential
Estimated Cost X$11/$1000 Commercial
An Additional $5.00 is added as an
Administrative charge.
Make sure that all fields are properly and legibly written to avoid delays in processing.
The undersigned does hereby apply for a Building Permit to build to f3 ve stated
specifications. Signed under penalty of perjury /;
Date
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