25 APPLETON ST - BPA-08-270 ROOFING T ,
CITYOIr En
PUBLIC PROPERTY
DEPARTNIE►NT
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130W&%UNGUW th1EEr•cAUK Mst11s01970
TUL 978-74S-9595♦FAX:9711 7iO4S"
E APPLICATION FOR THE REPAIR. RENOVATION. CONSTRUCTION.
_DEMOLITION. OR CHANGE OF USE OR OCCUPANCY. FOR ANY EXISTING
STRUCTURE OR BUILDING
1.0 SITE INFORMATION
Location New r S iuild1ng:
-- - Property Address:---
a.
Property is looted in a; Conservatlon Area YIN Historic District YIN L
j 2.0 OWNERSHIP INFORMATION
2.1 Owner of Land _
Name: P,4 R/6
Address: .Telephone: 5Z 7 6
3.0 COMPLETE THIS SECTION FOR WORK IN EXISTING BUILDINGS ONLY
Addition
Existing
Number of Stories
s Renovated
Change in Use New
Demolition Existing
Approximate year of Area per floor (sn Renovated
construction or renovation
of existing building New
Brief Description of Proposed Work:
- - ---Mail Pprmit to:
What is the current use of the Building?
Material of Building? if dwelling.how many units?
Will the Building Conform to Law? Asbestos? -
Archit ds Name
Address and Phone ( )
Mechanic's Name U ' a L L
Address and Phone -
Construction Supervisors License# (0 7/6 7 2 HIC Registration 0 S l
Estimated of of S 7d U Permit Fee Calculation
Permit Fee Cs�3J�
Estimated Cost X$7/$1000 Residential
Estimated Cost X S41/51000 Commercial------------ -- - --
An Additional $5.00 is added as an
` Administrative charge.
Make sure that all fields are property and legibly written to avoid delays in processing.
The undersigned does hereby apply for a Building Permit to build to the a ov to
speciticatlons. Signed under penalty of perjury
Date
Dry
0
`o
� ion y y 7
a
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