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5 PALMER ST - BUILDING INSPECTION I PUBLIC PROPERTY �x4 %a q / DEPARTMENT KI%IBF U.EY DRISCOU- MAYOR 1-V WASHINGfON STREET•S Alty,AMsACHt;st'I-a 01970 T EL-978-74S-9595 #FAM 978-740-9W APPLICATION FOR THE REPAIR. RENOVATION, CONSTRUCTION. DEMOLITION. OR CHANGE OF USE OR OCCUPANCY, FOR ANY EXISTING STRUCTURE OR BUILDING 1A SITE INFORMATION Location Name: Building: Property Address: Property is located in a; Conservation Area Y/N Historic District Y/N 2.0 OWNERSHIP INFORMATION 2.1 Owner of Land - S 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 Cemolition Existing Approximate year of Area per floor (sf) Renovated construction or renovation of existing building New Brief Description of Proposed Work: � N / 7 / Wj P?da-,,j �!R -2LgA Mail Permit to: )e FAy.W7Tg ST, LYn/N m;q, ni9�� What is the current use of the Building? 61-0 f1/0 U n/Z t- Material of Building? If dwelling, how many units? Z Will the Building Conform to Law? �/�S Asbestos? fy 0 Architect's Name Address and Phone Mechanic's Name /rL�.V�Zs`✓ Address and Phone J9 rIlYCM-A S i LyNr) MA , ©14D2 ��'�59JrgrjQ2� Construction Supervisors License# 495AHIC Registration # 2 0 Estimated Cost of Project$ Permit Fee Calculation Permit Fee $129,170 . 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 the above stated specifications. Signed under penalty of perjury X Dat421n- _0 w � y x c cc c F z e C7 9 0 a a a