27 WISTERIA STREET - BPA EI`I'7OFLEIC -
�o�� 'O� PUBLIC PROPERTY
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KI%BFJLLEY ORISCULL
MAYOR 120 WASHINGTON S`rREEf•S.LLkA1,MASSACHI:ShI'IS 01970
•141:978-745-9595 0 FAX 97&740.9g"
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.
W(STFR)t4 -5T- (41T 3
Property is located in a; Conservation Area Y/N IV Historic District Y/N
2.0 OWNERSHIP INFORMATION
2.1 Owner of Land
Name: r 4(I S a
Address: 2 / 1✓13
rm ^1 Q f 70
Telephone: 617 8L
3.0 COMPLETE THIS SECTION FOR WORK IN EXISTING BUILDINGS ONLY
Addition Existing
Renovation Number of Stories Renovated
Change in Use New
Demolition Existing OQ
Approximate year of Area per floor (sf) Renovated ?,0Q
construction or renovation
of existing building New
Brief Description of Proposed Work: 1
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Mail Permit to: rYavi 70
What is the current use of the Building? . .
Material of Building? tre k If how manyr-
Will the Building Conform to Law? �P S Asbestos? 4_6
Architect's Name
Address and Phone
Mechanic's Name
Address and Phone
Construction Supervisors License Q HIC Registration#
Estimated Cost �1�$ Permit Fee Calculation
Permit Fee$ Estimated Cost X$7/$1000 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 Wbuild to the above stated
specifications. Signed under penalty of perjury X
Date
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