30-32-42-94 AURORA LANE - BPA-2008-938 BLDG 84-REROOF . >. �
liuv',y' �5 u99ial � � .. ,,•;,
APPLICATION FOR PLAN E:XAiNi NATION AND BUILDING PIsRMCI
ALL STRUCTURF,S EXCEPT LAND 2 FAMILY DWELLINGS
IMPORTANT'. kpplicants must complete all items on rh is page
SITE INFORM TION yam,
Location Name /�Q/�. lifliy/V.ev!/!W/ Bui let in
Property Address„==
Map y
Located in: Conservation Are _Historic district
Use Groups
(check one)
Residential(3 or more Units) R2
Type of improvement Residential (hotel/motel R1
(check one) Assembly(churches) AI _
New Building__. .Assembly(nightclubs etc) A2
Addition Asscutbly (restaurants, recreation) A3_
Alteration Business B_
Repair/Replacement_ Educational E_
Demolition Factory (moderate hazard) FI _
Move/Relocate Factory(low hazard) F2 _
Foundation Only High Hazard 11 _
Accessory Building_ Institutional (residential care) 11 _
Other(describe) Institutional (incapacitated) 12_
Institutional(restrained) 13
Mercantile N1_
Storage(moderate hazard) S I _
Storage(low hazard) S2_
OW NERSIIIP INt'ORMA]ION(Please
�ttyppee or Prim Clearly)
SA�ll7Z�/�fEU l�riDOsr s _M T
OWNER Name �
Address-fXO U
Telephone( 8) �P,7ol A?eaq xoU
I ' 'RI I''VION OF v�f)RK 1I ':D
O
Q Q
J ry
ESTIMATED CO:NSTR UC'f1ON COST � ddd
i_
y
CONTRACTOR INFORMATION
Name
Address N/ D 6
Telephone
Construction Supervisor's Lic # GS 0 70 fD
Home lmprovement Contractor# /J3y5g
ARCIiITECT/ENGINEER INFORMATION
Name
Address
Telephone
Mass. Registration #
PERMIT FIE CALCULATION
Residential est. cost x $7/$I,000 + $5.00 =
Commercial est. cost x $11/$1,000 + $5.00= [
COMMENTS
The undersigned does hereby attest that all information stated above is true to the best
of my knowledge under the penalties of perjury /
�Z4Signed `
Date
r :-, 1b
TµCOWM
s � '
�' M '�'',