31 WEST AVE - BUILDING INSPECTION - EI`IY`Oi~SAL _
PUBLIC PROPERTY
Is
DEPARTMENT
KIsIDE "DRISCOLL
MAYOR 120 WASHING TON SrREEr♦SALEK MASSACHLSLI-175 01970
T -i:978-73i959S* Fnx:978-740-9946
APPLICATION FOR THE REPAIR. RENOVATION, CONSTRUCTION.
DEMOLITION. OR CHANGE OF USE OR OCCUPANCY, FOR ANY EXISTING
STRUCTURE OR BUILDING
1.0 SITE INFORMATION
Location Name: - Building:
Property Address:
Pro perty is k cmed in a; Conservation Area Y/N 0 Historic District Y/N 6
2.0 OWNERSHIP INFORMATION
2.1 Owner of Land _ d
Name: rJ 1 l nl
L
ress:ephone:
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
J
Brief Descripti Work Pr n of opos d :
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------- - Mail Permit to: -- ---
What is the current use of the Building?
Material of Building? rnJu 0 h If dwelling, how many units? 1
Will the Building Conform to L Iw?
Asbestos? Al
Architect's Name �,N i 'u� �I C�
Address and Phone
Mechanic's Name
Address and Phone
Construction Supervisors License# �b 71 UG HIC Registration#
a 1)o Permit Fee Calculation
Estimated Cost of Project$ �0--
Estimated Cost X$7/$1000 Residential
Permit Fee$
Estimated Cost X$11/$1o00 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 b ' to the above stated
specifications. Signed under penalty of perjury X
Date — D '
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