28 BARSTOW ST - BPA-2008-243 REROOF EITSt OF
DEP
�. PUBLIC PROPERTY
ART'bIENT
KP^wn w DUSCLAi.
�rAvaa 130%WAMUNGrM SMEEr•SA+hK NAsuaMM 01970
TEL.-M745-9S95•FA3c 978.740.9W
APPLICATION FOR THE REPAIR. RENOVATION CONSTRUCTION
DEMOLITION. OR CHANGE OF USE OR FOR ANY VaSTING
STRUCTURE OR WELDING.
1.0 SITE INFORMATION
Location Name: Building:
------ --- -
Properly is located in a.Conservation Area YIN Historic District YIN
2.0 OWNERSHIP INFORMATION
2.1 Owner of Land
Name: r
Address:
Telephone: — — �
3.0 COMPLETE THIS SECTION FOR WORK IN EXISXINCa BUILDINGS ONLY
Addition Existing
Renovation Number of Stories Renovated
Change in Use New
Demolition Existing
Approximate year of Area per floor (sf) Renovated
construction or renovation
of existing building New
Sdef Description of Proposed /Work:
-- - ---Mail Permit to:
What is the current use of the Building?
d� w� ll`
Material of Building? If dwelling.how many units? '
WIN the Building Conform to Law? Asbestos?
Architect's Name
Address and Phone l )
Mechanic's Name (d.�L�i-�/-%i o I&A ea f J 12
Address and Phone �/J �F' e Ste`
Cansbucdw Supervisors License# HIC Registration# l ��
Estimated Cost of O� Permit Fee Calculation
Permit Fes: Estimated Cost X i7/i1000 Residential
Estimated Cost X$11/$1000Commercial ------- ---
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 Perm to build to the above stated
� n^
specifications. Signed under penalty of perjuryAl
Date
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