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0023 ARBELLA STREET - BUILDING JACKET 23 Arbella St. CITY OF SALEM9 MASSACHUSETTS _ PUBLIC PROPERTY DEPARTMENT o �9MMeC�� 120 WASHINGTON STREET, 3RD FLOOR SALEM, MASSACHUSETTS 01970 STANLEY J. USOVICZ, JR. TELEPHONE: 978-745-9595 EXT. 380 MAYOR FAX: 978-740-9846 December 19, 2005 William & Kimberly Karademes 92 West Shore Drive Marblehead, Ma. 01945 RE: 23 Arabella Street Dear Mr. & Mrs. Karademes: The property mention above has been the subject of several complaints from surrounding neighbors. The complaints mainly are about the number of people living in the units and the subsequent parking problems caused by their vehicles. Several complaints also have been filed regarding noise at the property. Researching the records from this property identified a Board of Appeal decision from 1990 that allowed conversion of the property from a two family to a three family. The variance was granted with six conditions. Condition#5 states the property shall remain a three family as long as it is owner occupied. This condition is enforceable through the withdrawal of the variance. You are directed to contact this office upon receipt of this letter to discuss the resolution of this matter. I have enclosed a copy of the decision for your review. Sinc ely, ��.0 11 Thomas St. Pierre '✓ Building Commissioner Zoning Enforcement Officer cc: Mayors Office Councillor Sosuowski r APR 3.3 u�.avu[lb aity of Salem, 'ffltssi thusetts x. ITY elf ; .. �, • � Pnttra of c4pettl h J' DECISION ON THE PETITION OF GEORGE 8& KAREN TANCH FOR A VARIANCE AT 23 ARBELLA STREET (R-2) A hearing on this petition was held April 18, 1990 with the following Board Members present: James Fleming, Chairman; Richard Bencal , Edward Luzinski , Mary Jane Strigwolt and Associate Members Peter Dore and Arthur Labrecque. Notice of the hearing was sent to abutters and others and notices of the hearing were properly published in the Salem Evening News in accordance with Mass- achusetts General Laws Chapter 40A. Petitioners, owners of the property are requesting a Variance to allow property at 23 Arbella Street, which is located in an R-2 district, to be converted from a two family dwelling to a three family dwelling. The Variance which has been requested may be granted upon a finding by the Board that: a. special conditions and circumstances exist which especially affect the land, building or structure involved and which are not generally affecting other lands, buildings and structures in the same district. b. literal enforcement of the provisions of the Zoning Ordinance would involve substantial hardship, financial or otherwise, to the petitioner; c. desirable relief may be granted without substantial detriment to the public good and without nullifying or substantially derogating from the intent of the district or the purpose of the Ordinance. The Board of Appeal , after careful consideration of the evidence presented, and after viewing the plans, makes the following findings of fact: 1 . This petition was necessitated by the fact that a Special Permit to convert the existing two family house into a three family, previously granted, has lapsed. 2. The plans submitted by the petitioner indicate that existing plantings will be maintained. 3. The petitioner stated that substantial renovation of the building at 23 Arbella Street will begin promptly upon the granting of the requested relief. 4. The plans submitted by the petitioner indicate that the parking requirements of the Zoning Ordinance of the City of Salem will be met. 5. No opposition to the proposal was expressed. 6. Several parties spoke in faovr of the petition and correspondence in support of the petition was reard into the record. r DECISION ON THE PETITION OF GEORGE & KAREN TANCH FOR A VARIANCE AT 23 ARBELLA STREET, SALEM page two On the basis of =the above findings of fact, and on the evidence presented, the the Board of Appeal concludes as follows: 1 . Special conditions exist which especially affect the subject property but not the district in general . 2. Literal enforcement of the provisions of the Zoning Ordinance would involve substantial hardship to the petitioner. 3. The relief requested can be granted without substantial detriment to the public good and without nullifing or substantially derogating from the intent of the district or the purpose of the Ordinance. Therefore, the Zoning Board of Appeal voted unanimously, 5-0, to grant the Variance requested, subject to the following conditions: 1 . All conditions of the Salem Fire Department relative to smoke and fire safety are to be strictly adhered to. 2. A Certificate of Occupancy for the third unit is to be obtained from the City of Salem Building Inspector. 3. All construction and renovations are to be done in strict accordance with existing City and State Building Codes and as per plans submitted. 4. Five (5) legal parking spaces are to be maintained on site. 5. Property shall remain a three family only as long as it remains owner occupied. 6. All dimensions shall be as per the plans submitted. VARIANCE GRANTED ` o � J Mary Japt.Xtirgwolt, Mem , Board of Appeal A COPY OF THIS DECISION HAS BEEN FILED WITH THE PLANNING BOARD AND THE CITY CLERK pppeal from this decision,If any,shall be made pursuant t0 Sectloe 17 b the Mass. General Laws, Chapter 805.and shall be filed within 20 days after the date of filing of this decision in the office of the city clerk. y ... ^.5, Section 11, the Variance Pursuant to Mass. Generat Lass. r ct until a copy of decision,be , � n arng he certdicahonot 'r city that 20 days havehe elapsed and no appeal has been tiled, or that, if sjch appeal has been filed, that it has been dismisses or denied is recorcind in the South Essex indexedRegistry of Deeds ',no he name or the is recorded and noted ot the owner's h certificate ofTitle. owner of record a BOARD OF APPEAL CITY OF SALEM, MASSACHUSETTS �rBUILDING DEPARTMENT 120 WASHINGTON STREET, 30.0 FLOOR TEL. (978) 745-9595 FAx(978) 740-9846 KIMBERLEY DRISCOLL MAYOR THOMAS ST.PIERRE DIRECTOR OF PUBLIC PROPERTY/BUILDING COMMISSIONER March 3, 2006 1 George Atkins Esq. 59 Federal Street Salem, Ma. 01970 RE: 23 Arabella Street Zoning Violation Dear Mr. Atkins: Thank you for supplying this Department with your zoning research. I made copies of these materials and dispersed them to the members of the Zoning Board of Appeals as well as the City Solicitor, Elizabeth Rennard. We agree with your point regarding a "Variance" not running with an owner of a property. However, the Board Chairman and I both feel the Board of Appeals can lawfully impose the condition that requires owner occupancy for the additional unit. If you wish to appeal this interpretation, your appeal is to the Salem Zoning Board of Appeals. Sincerely, Thomas St. Pierre Zoning Enforcement Officer cc: Mayors Office Councillor Sosnowski City Solicitor, Elizabeth Rennard � �itp Df. �dYETIi, �A$$AL�U�Etrg Public Propertp Mepartment �3uilbing -Department One sealem Oreen (976) 745.9595 Cxt. 350 Peter Strout Director of Public Property Inspector of Buildings Zoning Enforcement Officer September 10, 1999 ®PV William Karademos 23 Arbella Street Salem, Ma. 01970 RE: 23 Arbella Street Dear Mr. Karademos: This office has received a complaint concerning the illegal rental of your apartment located at 23 Arbella Street. The Salem Zoning Ordinance, Section 5.2 prohibits the rental of a dwelling unit to more than three (3) unrelated people. Please contact this office upon receipt of this letter to schedule an inspection of your property. Thank you in advance for your anticipated cooperation in this matter. Sincerely, Frank R. DiPaolo Local Building Inspector cc: Councillor Flynn, Ward 2 Y r .EONI;It, - CERTIFICATE ISSUED N CITY OF SALEM DATE April 1 . 1991 ° SALEM. MASSACHUSETTS 01970 BUILDING PERMIT - P4ODmE1 CERTIFICATE OF OCCUPANCY DATE 6/14 19 90 PERM NO 32490 T APPLICANT Gary Green ADDRESS Cross 6t�Beger�Y. M . I.O.I ISTREETI ICO-I-'S EI[E.(EI PERMIT TO Addition. pwellinq. NUMBER OF I_1 STORY DWELLING UNITS ITvP( Of IMPROVEMENT) NO. IPPO.OSED U((1 AT (LOCATION) - arwis Jt. 1'YC1LU W rA 2 ZONING R-2 DISTRICT 1x0.1 IS1R[(TI BETWEEN AND ICPOSS STREET) (CROSS STREET) SUBDIVISION ` LOT BLOCK SPIE BUILDING IS TO BE FT. WIDE P., FT. LONG BY FT. IN HEIGHT AND SHALL CONFORM IN CONSTRUCTION TO TYPE USE GROUP BASEMENT WALLS OR FOUNDATION ITYPEI REMARKS: Addition 8'x13' to second floor, diking 2 family into 3 family as per Board of Appeal. CALL FCR PERMIT TO OCCUPY 745-9595 X101 AREA OR VOLUME INNER .In-W. C :RIC:SOV/AE PEER to I George Karen& KTAnchgi - sewer.orrb�Is�IverlbeiloF[loens'SlseTloa�se+seno € Im IS�y OWNER ADDRESS 23 Arbella St. Salem, AA. SEE NEVER T C a'V'TEDBIeOIO T,E BUILDING PERMIT JOB WEATHER CARD DATE 6/ 14/ 19 90 PERMIT NO. 324-90 APPLICANT Gary Green ADDRESS 36 Cross St . , Beverly ,MA 899 (NO.) (STREET) (CONTR'9 OCENSEI ADDITION DWELLING NUMBER OF THREE PERMIT TO l_I STORY DWELLING UNITS 1 (TYPE Of IMPROVEMENT) NO. (PROPOSED USE) 23 Arbella Street Ward 2 ZONING R-2 AT (LOCATION) DISTRICT (NO.1 ISTREETI BETWEEN AND IERGlS STREET) ICR099 STREET) LOT SUBDIVISION LOT BLOCK SI2E BUILDING IS TO BE FT. WIDE BY FT. LONG BY FT. IN HEIGHT AND SHALL CONFORM IN CONSTRUCTION TO TYPE USE GROUP BASEMENT WALLS OR FOUNDATION (TYF31 REMARKS: 8 'X13 ' ADDITION TO SECOND FLOOR, MAKING 2 FAMILY INTO 3 FAMILY GRANTED B.O .A. 4 / 18/90 CALL FOR PERMIT TO OCCUPY 745-9595 AREA ORESTIMATED COST $ 25 ,000 . 00 000 . 00 FEEMIT VOLUME 7 'CUBIC/sou ARE SECT( George T_anch OWNER23 Arbulta St . , BUILOII ,_-J, Id(!•� 4Y 0DRE55 B � THIS PERMIT CONVEYS NO RIOHT TO OCCUPY ANY STREET. ALLEY OR SIDEWALK OR ANY PART THEREOF. EITHER TEMPORARILY OR PERMANENTLY. ENCROACHMENTS ON PUBLIC PROPERTY. NOT SPECIFICALLY PERMITTED UNDER THE BUILDING CODE, MUST BE AP- PROVED BY THE JURISDICTION. STREET OR ALLEY GRADES AS WELL AS DEPTH AND LOCATION OF PUBLIC SEWERS MAY D! OBTAINED FROM THE DEPARTMENT OF PUBLIC WORKS. THE ISSUANCE OF THIS PERMIT DOES NOT RELEASE THE APPLICANT FROM THE CONDITIONS _^-OF ANY�IPP LICA pLE SUBDIVISION RESTRICTIONS. INSPECTIONS REOUIREOCALL FOR APPROVED PLANS MUST BE RETAINED ON JOB AND THIS PFRM TS APPLICABLE RlOUIRHDA RATE FOR ALL CONSTRUCTION WORK( CARD KEPT POSTED UNTIL FINAL INSPECTION HAS BEEN ELECTRICAL, PLUMBING AND 1.FOUNDATIONS OR FOGTING3. MADE. WHERE A CERTIFICATE OF OCCUPANCY IS RE- MECHANICAL INSTALLATIONS. 2. PRIOR TO COVERING STRUCTURAL OUIREO,SUCH BUILDING SHALL NOT BE OCCUPIED UNTIL - wr MHMBEfl51READY TG LATH(. FINAL INSPECTION HAS BEEN ECTION MADE. - AMY S. FINAL INSPBEPORE �-.:J<x;'T�'•�' - - OCCUPANCY. POST THIS CARD SO IT IS VISIBLE FROM STREET BUILDING INSPECTION APPROVALS PLUMBING INSPECTION APPROVALS ELECTRICAL INSPECTION APPROVALS dLL 1� I ?/'12'12 0 2,3 il�A ` . ROOF HEALTH '- OAS INSPECTION APPROVALS EPT.,INSP TING APPROVALS 1 T OTHER CITY ENGINEER 2 2 WORK SHALL NOT PROCEED UNTIL THE [PORMIT RMIT WILL BECOME NULL AND VOIDIFCONSTRUCTION INSPECTIONS INDICATED ON THIS CARD INSPECTOR HAS APPROVED THE VARIOUS RK IS NOT STARTED WITHIN SIX MONTHS OF DATE THE CAN RI ARRANGED FOR BY TELEPHONE STAGES OF CONSTRUCTION. IS ISSUED AS NOTED ABOVE. ' ,_ OR WRITTEN NOTIFICATION. �x""°"` CtU of ttlem, 4Ra59ar4116e##6 Public Propertg Departineut s Puilbiug 3Ippartntent QOnr �&ulem (6reen 7,13-0213 William H. Munroe Director of Public Property Maurice M. Martineau, Asst Inspector Inspector of Buildings Edgar J. Paquin, Asst Inspector Zoning Enforcement Officer John L. LeClerc, Plumbing/Gas Insp. February 3, 1988 Mr. James B. Hacker 7 Ugo Road Salem, MA 01970 RE: 1 23 Arbella Stree6 Salem;MA–j Dear Mr. Hacker, A Special Permit to convert a two family into a three family at 23 Arbella Street was Granted by the Board of Appeal, which was based on adequate parking shown on a Certified Plot Plan submitted by Mr. Bowman. An application for a Building Permit at said property was denied due to a discrepancy in said Certified Plot Plan. City records indicate that the rear of the property shown on the plot plan submitted does not , in fact, belong to Mr. Bowman. Due to our findings, we feel it is necessary to notify the Board of Appeal. —Sincerely,, David J. Harris DJH/eaf C.C. City Solicitor City Clerk Administrative Aide Ward Councillor , �0.t IL4 Y� Chit of ttleilt, � a5saC11119 tts %s •-•fes ire department iieabquartcrz Il11NE� 48 `da41cite '�'blrcet Joseph F. Sullivan �n(rm, Ain. 01970 Chief Date: June 4, 1986 City of Sal-em RE T23 Arbella St er et Board of Appeal sRobert"B-Bowman' One Salem Green Salem, MA •01970 Sirs: As a result of the notice received concerning the Board of Appeal hearing for the above listed name and address, the Salem Fire Department requests the following items to be placed on record: The Salem Fire Department has no objection to the granting of a Special . Permit to convert a two family dwelling into a three family dwelling. The property is currently in compliance with the installation of automatic smoke detectors for a two family dwelling. If the Special Permit is granted it will be required to,:have a complete change of the automatic smoke detector system from battery operated to hardwired (11OV.A.C. ) throughout the building. This is requirement is mandated by the Massachusetts Gene- ral Laws,: Chapter 148, Section 26E. Respectful , Norman P. LaPointe Fire Inspector cc: Appellant Building Inspector - File F01-111 It105 ; y,CON Wf{�F CtU of *nljoni, Aassar4usetta A ]iublir Property Pepartinent WL���� uilliuq epttrtntent One 3enlem ofireen 7,15-02 13 William H. Munroe Director of Public Property Maurice M. Martineau, Ass't Inspector Inspector of Buildings Edgar J. Paquin, Asst Inspector Zoning Enforcement Officer John L. LeClerc, Plumbing/Gas Insp. February 1 , 1988 Robert & Jean Bowman - 7 Fairview Avenue Salem,MA 01970 RE: c23 Arbeila St:,;Salem,MA Dear Robert & Jean, Your application for a permit at 23 Arbella Street has been denied. Examination of your Certified Plot Plan differs from City plan records. Due to the possible lack of adequate parking, we cannot issue a permit at this time. Sincerely, David J. Harris - Assistant Building Inspector DJH/eaf 77 NOTES A" REMOVE EXISTING PAVEMENT, 1. LOCUS IS SHOWN ON SALEM ASSESSORS MAP 36, LOT 394. EXISTING CONDITIONS ons CREATE A SHALLOW LAWN /' �p� LOWER FINISHED GRADE TO 'yam DEPRESSION: INSTALL ".�— p� C FATE PAVED SWALE. % SHIM EXIST NG BINDER TO PITCH TOWARDS PER ACTUAL ON-THE-GROUND SURVEY BY NORTH SHORE SURVEY CORPORATION, J Rs 2-FEET DEEP 2 CRUSHED \/ / / pyo 8r PAVED SWALE. AUGUST, 2006. ELEVATIONS SHOWN ON THIS PLAN ARE NOT BASED ON NGVD OF z N7, //P� a - - - < STONE, 4" LOAM, THEN r .�. -- ° 1929 (MSL-0.0) DATUM. ELEVATIONS SHOWN ON THIS PLAN ARE NOT BASED ON CITY C ! GRASS SEED. DATUM ELEVATION SHOWN ON THIS P 100.60 OF SALE LAN ARE BASED ON AN ARBITRARY DATUM: M BW:99. ( ATCH FIN. GRADE AT FENCE)8� 8M CE / % M TBM#1 = 100.0 PK NAIL SET IN PAVEMENT TBM#2 = 99.85 PK NAIL SET IN PAVEMENT. + , \/// - r- SMALL PT WALL 2. THIS PLAN DOES NOT REPRESENT COMPLIANCE WITH CITY OF SALEM'S ZONING ,/ 6 J ja s, SITE \\ / PAVEMENT SHALL BE 2-FEET BY-LAWS. - °4 ,� ,; MINIMUM SETBACK FROM ,° 8"' , •� I W PROPERTY LINE. 3. THIS PLAN DOES NOT SHOW ALL UTILITY LINES (AND/OR UNDERGROUND f L ;tea ' CONDUITS) SINCE FIELD SURVEY WAS PERFORMED ON VISIBLE ABOVE-GROUND sr' J a" =�4, o w I STRUCTURES ONLY. THE LOCATIONS OF EXISTING UNDERGROUND UTILITY LINES SHOWN � m `b i ° ON THIS PLAN ARE APPROXIMATE BASED ON THE BEST AVAILABLE INFORMATION GIVEN TV.100.55 TO PLDE AT THE TIME OF THE PREPARATION OF THIS PLAN. -BW:100.0(MATCH FIN. GRADE AT FENCE) PIDE DOES NOT CERTIFY THE PHYSICAL CONDITION OF EXISTING UTILITIES. PRIOR TO ANY SITE WORK, THE SITE CONTRACTOR SHALL NOTIFY DIG-SAFE AND VERIFY LOCATIONS OF ALL UTILITY LINES ON THE SITE AND ADJACENT TO THE SITE WITHIN THE AREA OF THE SCOPE OF WORK. PLDE IS NOT RESPONSIBLE (OR LIABLE) FOR TBM1 j I ANY BROKEN (OR DAMAGED) UTILITY LINES BEFORE, DURING OR FOLLOWING SITE �5� •� EXCAVATION/CONSTRUCTION. 5" 4. ANY AND ALL CONSTRUCTION METHODS, MATERIALS, INSTALLATIONS AND ire ) sl ° ' ' DEMOLITIONS SHALL COMPLY WITH STATE AND LOCAL PERMITS, LOCAL AND STATE EXISTING PAVED AREA , 0 1' BUILDING CODES, CITY OF SALEM PUBLIC WORKS DRAIN LAYERS MANUAL, CITY OF »:• %A I NOTE: PAVEMENT GRADES SHOWN SALEM DPW/ENGINEERING DEPT. SPECIFICATIONS AND CONDITIONS, MASS. HIGHWAY ARE FOR BINDER COURSE. DEPT. SPECIFICATIONS, AND GOOD ENGINEERING/CONSTRUCTION PRACTICES FOR s ' SOLID/PERMANENT AND AESTHETICALLY PLEASING CONSTRUCTION. rip,• L� � %� � ° a��s < INSTALL PROPER THRESHOLDS ° 5 AS PART OF CONSTRUCTION, THE SITE CONTRACTOR SHALL MAKE FIELD �'- mow. AT EACH DOORWAY AS `100'4` REQUIRED, SO THAT RUNOFF° ADJUSTMENTS AS REQUIRED BASED ON ACTUAL CIRCUMSTANCES AND TO RECTIFY ANY WATER DOES NOT ENTER THE ' �g" DESIGN DISCREPANCIES IN ORDER TO COMPLY WITH LOCAL/STATE BUILDING CODES, DOORWAY. / " % •° "' MHD SPECIFICATIONS AND ABOVE MENTIONED REQUIREMENTS FOR CONSTRUCTION. / - 0 200 s �' 6. THIS PLAN IS INTENDED ONLY TO OBTAIN THE ENGINEERING DEPT. DRAINAGE LOCUS SCAGRALE IC % Yea ' ALTERATION APPROVALS FROM THE CITY OF SALEM FOR THE RE-CONSTRUCTION OF A SCALE:1"=200' PORTION OF THE EXISTING PAVED PARKING AREA AS SHOWN ON THIS PLAN. THE ji ACTUAL CONSTRUCTION PERMIT FOR CONSTRUCTION OF PAVEMENT SHALL BE ISSUED TO THE SITE CONTRACTOR. P,°. " r o � OF s9c o SCOTT IAN PATROWICZ N o p SG N o CIVIL No.33656 O EHE Z I , 3 W GRAPHIC SCALE 8� PLANS NOT FOR CONSTRUCTION, z +o o a to zo :a PLANS FOR PERMITTING PURPOSES ONLY 0. F f} C] 0 tinch ' >ti DRAINAGE Cmo ALTERA110N A � Q �� 8y" SKETCH PLAN W COMPLIANCE # 23 Arbella Street < THE FOLLOWING COMPLIANCE REQUIREMENTS ARE PER CITY ENGINEER: Salem, Massachusetts N ONCE THE (PROPOSED CONSTRUCTION) WORK IS COMPLETED, AND PRIOR TO A SIGN OFF FOR OCCUPANCY BY THE CITY ENGINEER, � THE FOLLOWING MUST BE COMPLETED: Date: September 5, 2006 Q /� B E L L A PLDE#06-34 Scale: 1" = 10' Sheet 1 of 1 1. AN AS-BUILT DRAWING STAMPED BY THE DESIGN ENGINEER SHOWING ANY CHANGES TO THE DESIGN DRAWING AND ACTUAL A Y WORK COMPLETED, THIS AS-BUILT DRAWING SHALL BE IN AN ELECTRONIC FILE FORMAT (AUTOCAD .DWG AND/OR ADOBE PDF) R E E T Prepared for: William Karademos SUITABLE FOR THE CITY'S ACCESS AND USE. 92 West Shore Drive, Marblehead, MA 01945 J 2. A CERTIFICATION STAMPED AND SIGNED BY THE DESIGN ENGINEER, STATING THAT THE WORK WAS COMPLETED IN PATROWICZ SUBSTANTIAL COMPLIANCE WITH THE DESIGN DRAWING, AS WELL AS, ANY SUBSEQUENT CODE REQUIREMENTS BY THE CITY L ENGINEER. a TBM 2 LAND DEVELOPMENT ENGINEERING e" # 14 Brown Street, Salem, MA 01970 (978) 836-6400 W U LU O a z z 3 0 CITY OF SALEM ' PUBLIC PROPERTY DEPARTMENT KINMERI.EY DRISCOLL MAYOR 120 WASHINGTON STREEr♦SALEm,MASSACHUSEITS 01970 1Ei 978-745-9595 ♦ FAx:978-740-9846 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: (9,3 i4R ge)k r4 S%. �J � eti r MA. 0 0 Property is located in a; Conservation Area Y® Historic District Yo 2.0 OWNERSHIP INFORMATION 2.1 Owner of Land Name: ai 11v K JN C-Pvot e e..oS Address: 7a L,;-eSTS/-lorQ 'br'- M 4r-W e-H e A 1 Telephone: 7151- to 3 1- -Zaa3 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 (sf Renovated construction or renovation of existing building New Brief Description of Proposed Work: dip Z1 a�e<s l r�SN le A,c_ casTfe c. c .r Mail Permit to: 4 tJAlker RA� eeAS�y WIA. o146o What is the current use of the Building? r-en rTA- w Material of Building? If dwelling, how many units? Will the Building Conform to Law? yrS Asbestos? Alto Architect's Name Address and Phone ( ) (ZpaFMechanic's Name C- (aSTIe C L T Address and Phone -f 6y.41 k e♦ kc( • 00,eASodc4 M-4 • n Omer (o 0 Construction Supervisors License# OS98N), HIC Registration # l 7 g4CD Estimated Cost of Project$ ,70Z 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 to build to the above stated specifications. Signed under penalty of perjury X Date 7 S o of � ;^ N O U ` 6., y Zl e V� V `o o > 1