62 BEAVER ST BPA-2008-400 ROOFING EITY-OF --
PUBLIC PROPERTY
DEPARTNIE►1TT
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MAYOR 130 WAS MGWW SIXEW•'•••K MAMAC+Lst1'rs 01970
7tL•979-74S.9S9S•FAQ 97L740in"
APPLICATION FOR THE REPAIR. RENOVATION CONSTRUCTION
DEMOLITION, OR CHANGE OF USE OR OCCUPANCY FOR ANY EXISTING
STRUCTURE OR BUII.DING
1.0 SITE INFORMATION
Location Nana: � 8 l Building:
-r-OL2,- t-L—
Projeriy g z`
Is located In a.Conservation Area Y/N Historic Otabict Y/N
2.0 OWNERSHIP INFORMATION
2.1 Owner of Land `
Name: /- O
Address:
Telephone:
3.0 COMPLETE THIS SECTION FOR WORK IN NISTING BUILDINGS ONLY
Addition Existing
Renovation Number of Stories Renovated
Change in Use Now
Demolition Existing
Approximate year of Area per floor (sf) Renovated
construction or renovation
of existing building New
Brief Description of Proposed Work:
-- ----Mail Permit to:
What is the current use of the Building?
Material of Building? If dwelling.how many units?
WIN the Building Conform to Law? Asbestos? -
Architect's Name
Address and Phone )
Machanies Name
Address and Phone
ConstnicUon Supervisors license HIC Registration#
Estimated Cost or Project s .�� Pertnil Fee Cak:ulatbn
Estimated Cost X$7/57000 Residential
Permit Fee i
- --- - - -_ Estimated Cod X S41/il000 Commercial---------- -
An Additional $5.00 is added as an
AdministratNe charge.
Make sure that all fields are properly and legibly written to avoid delays in processing.
The undersigned does hereby apply for a Build[ Pe it to build to the a e stated
specifications. Signed under penalty of perjury
Date D
of
N
3
O
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