27 SALEM ST - BUILDING INSPECTION Y •
What is the current use of the Building? �Q�
Material of Building? a`� If dwelling,how many units?.
Will the Building Conform to Law? Asbestos?.
Architeds Name
Address and Phone l )
Mechanic's Name
Address and Phone ll
Construction Supervisors License 5 HIC Regis>fatbn f/
� Permit Fee Calculedw
Estimated Cost 1OflProjed Ste_
Permit Fee S Estimated Cost X$71S1000 Residential
Estimated Cost X S111S1000 CommerCW An Additional$5.00 is added as an
Administrative charge.
Make sure that all fields are properly and legibly written to avoid delays In proceeeing.
The undersigned does hereby apply for a Building Permit to bull to the above stated
specifications. Signed under penally of pe jury
,&=/=
Date
bl
s4<
N
o �
F Z
,� N a
— - - - w 4- .� — --
ErrroF-
PUBLIC PROPERTY
DEPART1IEINT
K1%QWA fiV ONSC aL
MAWS 130 WASMNG nm SnLEfT 'y11iK%IASSAOA'St11S 01970
976749-9s"9 FAX 976740""
IR.APPLICATION FOR THE REPA RENOVATION. CONSTRUCTION.
DEMOLITION. OR CHANGE OF USE OR OCCUPANCY, FOR ANY EXISTING,
STRUCTURE OR BLTMDIING
1.0 SITE INFORMATION
Location Name: Building:
Property Address
Property Is Waded in a;Conservation Area Y/jg Historic Dletrict Y/fl
2.0 OWNERSHIP INFORMATION
2.1 Owner of Land
Name:
Address:
Telephone:
3.0 COMPLETE THIS SECTION FOR WORK IN EXIST G BUILDINGS ONLY
Addition Existing
Renovation Number of Stories Renovated
Change in Use Now
Demolition Existing
Approximate year of Area per floor(so Renovated
construction or renovation
of existing building New
Brief Description of Proposed Work:
— - - -- Mail Permit to: JA ) j�,V�