11 BARTON SQ - BPA-2008-623 REMODEL KITCHEN EITStQFgXGE1G __
PUBLIC PROPERTY
DEPARTNIF.,�1T
KMOSEALEY DRKCOL
MAYOR 130 WAS UN "SMM 0 Sntlx N.mAou;scTR 01970
MM.93-745-9M*FAX 978-740-990 ..
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: qNMcts t Njm a Building:
-- Property Address:-kV- i' t6N_ -'dti203- - ---- -- -- -
saa&m . * u. . 0191 O
Property Is located in a;Conservation Area YIN tJ Historic OwbRA Y/N hi _
2.0 OWNERSHIP INFORMATION
2.1 Owner of Land
Name: Q o6\e
Address: \\ Z O x pt,r S'\ 14 203
Telephone: Am _ 'i4 S _ S-1 g Lt.
3.0 COMPLETE THIS SECTION FOR WORK IN EYISIING BUILDING$ 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
9det Description of Proposed Work:
4 .1
—— -- Mail Permit to: - --
What is the current use of the Building? I
Material of Building? brew L.Z%O If dwelling.how many unit$?
we the Building Conform to law? nQ-S Asbestos? Na
Arch-does Name
Address and Phone ( )
Mechanics Name rr1 fo Est
Ca\'l 5�2 \t l)2 353 vo .[r 4vs Q1u�ae.n wnya . o2u.1
Address and Phone '
Conatrur lion Supervisors license# 411 3�_HIC Registration# 1.'t 8344
Estimated Cost of PrAsct S '0•oao0• 0 Permit Fee Calculiedw
permit Fee i
Estimated Cost X$71S1000 Residential
Estimated Cost X$11/111000 Commercial—An Additional $6.00 is added as an
Administrative charge.
I
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
Date
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