24 BARSTOW ST - B-2007-127 ROOF F—S 11 --
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PUBLIC� ✓� �' � � C PROPERTY
DE PAR'TIMENT
KI%IBFIU.EY DRISCOLL
MAYOR • ,�,
120 WA.sHING oN SYREsr•S AWA.MASSACHLSEI-M 01970
TFt 978-745-9595♦FAx:978.740-9946
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: ,gam -�� Building:
Property Address:
2 /J =
Property is located in a; Conservation Area Y/N Historic District Y/N
2.0 OWNERSHIP INFORMATION
2.1 Owner of Land
Name: GFaJ C
Address:
Telephone:
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 (so Renovated
construction or renovation
of existing building New
Brief Description of Proposed Work:
Mail Permit to: -
What is the current use of the Building?
�Val ire
Material of Building? cjQrb If dwelling, how many units? f
Will the Building Conform to aw? a Asbestos? /�t7
Architect's Name
Address and Phone
Mechanic's Name
Address and Phone
Construction Supervisors License# ay.Ss90 HIC Registration# ///969
Estimated Cost of Project$ oa Permit Fee Calculation
Permit Fee$ Estimated Cost X$71$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 th ova t
e a
specifications. Signed under penalty of perjury
Date 9 O6
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