1B SPRUANCE WAY - BUILDING INSPECTION erry OFSALENr---
PUBLIC PROPERTY
DEPARTMENT
KImSERIEY DRISCOLL
MAYOR 120 WASNINGrON S-MEr•&UEK MtiSACHI I-M 01970
To-,978-74S-9S9S 0 FM 978.740-95" �.
APPLICATION FOR THE REPAIR, RENOVATION, CONSTRUCTION.
DEMOLITION OR CHANGE OF USE OR OCCUPANCY, FOR ANY VaSTI NG
STRUCTURE OR BUILDING
Wr
1.0 SITE INFORMATION
Location Name: �• �„ Building:
Property Address: !�Q s� r vc✓�Ge �✓
property is located in a; Conservation Area YIN /-J _Historic District Y/N
2.0 OWNERSHIP INFORMATION
2.1 Owner of Land
Name: Q 1h Ufic
Address: % S�r �iq�C r ✓ G 7/
Telephone: 9-79 - 71-1` .;,-,9
3.0 COMPLETE THIS SECTION FOR WORK IN EXISTING BUILDINGS ONLY
Addition Existing
Renovation Number of Stories Renovated
Change in Use New
Demolition Existing
Approximate year of Area per floor (so Renovated
construction or renovation
of existing building New
Brief Description of Proposed Work:
4� Gov,r
-- Mail Permit to: /<74, ,3c1>0 9,Za ,V
What is the current use of the Building?
Material of Building? if dwelling, how many units?
Will the Building Conform to Law? Asbestos?
Architect's Name
Address and Phone l )
Mechanic's Name
Address and Phone
Construction Supervisors License# HIC Registration#
Estimated Cost of Project$ 00 d D Permit Fee Calculation
Permit Fee$ Estimated Cost X$7/111000 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 bull the above stated
specifications. Signed under penalty of perjury
Date a�
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