17-19 SALEM ST - BUILDING INSPECTION (2) What is the current use of the Building? �1 lPl(` �/SQ'
Material of Building? �'�+s it dwelling, how many units?
Will the Building Conform to Law?
f/5 Asbestos? _j✓ t�
i
Architect's Name
Address and Phone I j
Mechanic's Name V �
Address and Phone h�n9r ' ti r
Constnictian Supervisors License# HIC Registration# A-/ 3 6 fS
Estimated Cost of Project S . 3� Permit Fee Calculation
Permit Fee S 33 _ Estimated Cost X$7/$1000 Residential
Estimated Cost X$11/$1000 Commercial
3 An Additional $5.00 is added as an
Adminisrative charge.
00�D
Make sure that all fields are property and legibly written to avoid delays in processing.
3�17 The undersigned does hereby apply for a Building Permit to bull to the above s ted
specifications. Signed under penalty of perjury X
Date
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-- - - w 4 �— - — —
_ 1
--` F;I`I'�' OF�ALEtit—
` 3�' PUBLIC PROPERTY
CK DEPARTME.INT
AIMSFA ov DRLUX L
MAraa 130 WAsmNGww h rimb YLLka4 M.usAaLSkIIS 01970
TFi 979-745-9595 0 FAX 976740.9046
APPLICATION FOR THE REPAIR, RENOVATION% CONSTRUCTION
DEMOLITION, OR CHANGE OF USE OR OCCUPANCY, FOR ANY EXISTING
STRUCTURE OR BU"ING
1.0 SITE INFORMATION
Location Name: ('CAAPIC` V1'r) Building:
Property Address: /7- 2/ SA ieM ST
SA)em s 01170
Property 1:located in a,, Conservation Area Ym--- Historic Ctw YIP!
2.0 OWNERSHIP INFORMATION
2.1 Owner of Land
Name: e A W, KO )ev
Address: -j?AC9je 1A
SRO VS 5S 61y
Telephone: `7 - a -301. S
3.0 COMPLETE THIS SECTION FOR WORK IN EXISTING BUILDINGS ONLY
Addition Existing
Renovation Number of Stories Renovated
Change in Use N.
Demolition Existing
Approximate year of Area per floor (sf) Renovated
construction or renovation
of existing building New
EL&J Description of Proposed Work:
�v
-- - - Mail Permit to: --�Iy� �s� �-