3 ALLEN ST - BPA-07-419 DEMO ADDITION, BUILD NEW ADDITION -EI' ��LEiC
i� PUBLIC PROPERTY
DEPARTMENT
KIS BM-EY DRLSCOL L
MAYOR
120 W,LSHING7'ON S7xEtsi*S•'`„AAhSACµL5t115 01970
TFL-978-745-9595 •FAx:978.7i0-9&"
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:
Property is located in a; Conservation Area Y/N _ Historic District Y/N ^1
2.0 OWNERSHIP INFORMATION
2.1 Owner of Land
Name: _P
Address:
Telephone: s-;7
3.0 COMPLETE THIS SECTION FOR WORK IN FYtcTING BUILDINGS ONLY
Addition SAD/ Existing
Renovation Number of Stories Renovated
Change in Use New
Demoli5on Existing
Approximate year of Area per floor (so [New
vated
construction or renovation
of existing building
Brief Description of Proposed Work:
ppmo/SCC C'' Kis71, g aa101i)4iGx
Mail Permit to:
What is the current use of the Building? %moo r
Material of Building? u) orb If dwelling, how many units?
Will the Building Conform to Law? Asbestos? n b
Architect's-lame-
_Address-and-Phene
ianic's Name
_Addressand- hone—
ConstructiahSupervisors License# HIC Registration#
Estimated Cost of Project CW_ Permit Fee Calculation
Permit Fee$J S'410 7�a .o D 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 o
Date
0
6.
N
ems+
r. N
\I r6
91
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