3 ALLEN ST - BPA-07-420 BLD 2 STORY ADDITION/ZBA APPROVE 1.
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a 5 o PUBLIC PROPERTY
DEPARTMENT
KISRIERI.EY DRISCOLL
MAYOR
i?0 WASHINGTON SrIIEEi*S1L1:i,y,��(-HLSt17501970
'ILL 978-745-9595 1 FA)c 978-740-99"
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:
Ae
Property is located in a; Conservation Area Y/N 14 Historic District Y/N
2.0 OWNERSHIP INFORMATION
2.1 Owner of Land a
Name: 02
m�
Address: 3 A¢ Ivy Sf.
Telephone: 97S 7�/S=G6_5-- 7
3.0 COMPLETE THIS SECTION FOR WORK IN EXLSILNG 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:
A'e6v;ld s for «
i x
Z
Mail Permit to:
F
What is the current use of the Building?
Material of Building? ,0 o/ If dwelling, how many units?
Will the Building Conform to Law? t/f% Asbestos?
c itect's Name
-AZE ress and Phone j
,Mechanic's-Name
Address-and--Phone
, -COAstructlon-Supervisors-License# HIC Registration#
Estimated Cost of Project$32 Ste• Permit Fee Calculation
Permit Fee $ 5 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' �--
Date /f aP D G
3
35
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CPTY OF $ALFm
' PUBLIC PROPERTY
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af,,,"°a �3owi�s�micron srsaat•s..ntiwuuoa�,smrr.
Constrncdos Debris Disposal Affidavit
(mqulrad fa all demolitbs sod reaovadan wank)
Is aceotdtmos with d w sixe6 edidm of dw Stet Hnildinf Coder.M CUR section 111.11
i)eb"and d»provisions of UM a 4%9 34
guildft Ift h is issasd with tbo oondWon that d►e debris=Mns hoes
tMs wart fbsll be disposed of is a properb►lleeosed waft&Rmd hrdUW an dellm d by M(S.o
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the dcbris will be disposed of in:
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