9 SALEM ST - BUILDING PERMIT APP EI'I'Y OFLEl�
PUBLIC PROPERTY
DEPr1RT'NIENT
MAYM 130 W Tr%EW 3uAjK NAMAoa:wris 01970
TW 91.1-743.9493•FAX:M7W%ft
APPLICATION FOR THE REPAIR. RENOVATION, CONSTRUCTION,
DEMOLITION, OR CHANGZ OF USII OR OCCUPANCY. FOR ANY EXISTING
STRUCTURE OR BUILDING
1.0 SITE INFORMATION
Location Name: Build ft
Prop"gddross:----
� C 2 r
Property is located in a:Conservation Area YIN HW"Ic Obbiet YIN
2.0 OWNERSHIP INFORMATION
2.1 Owner of Land
Name:
Address:
Sn > r.PLe 4 S 5 6)14T
Telephone 6/' �6�C'- 1ye 9 -06/
3.0 COMPLETE THIS SECTION FOR WORK IN EXISnW BUILDINGS ONLY
Addition Existing
Renovation Number of Stories Renovated 2, S
Change in Use New
Demolition Existing
Approximate year of Area per floor (sf) Renovated
construction or renovation
of existing building New
t3riel Description of Proposed Work:�
ao
io � — - -- - - - . .-- --
Mail Permit to: Ls d..Lee , VhA-SS tL/ y S
What is the curtest use of the Building?
Material of Building? It dwelling.how matey units? s1L�
"I the Building Conform to Law? Asbestos? -
Archited's Name
Address and Phone c
MeehanWs Name
Address and Phone HIC Registration 0_LLLL7 b J
Construction Supervisors Win" � ,
Estimated Cost of Proled S 1 Permit Fee CakulsdOn
Permit Fee S t •d�a Estimated Cost X$7/$1000 Residential
Estimated Cost X SM411000 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 Date
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