23 BECKET ST - BPA-2007-862 ROOF CnY OF
PUBLIC PROPERTY
DEPARTMENT
K,.awim s„oamom
MAYM
120 W W WrON SMEEr 6 S,ui K MAAA«ISk-1-M 01970
14i 978-745-959S•PAX.97S.740.9S46
APPLICATION FOR THE REPAIR, RENOVATION CONSTRUCTION,
DEMOLITION OR CHANGE OF USE OR OCCUPANCY FOR ANY EXISTING
STRUCTL�F OR BUILDIN[`
1.0 SITE INFORMATION
Location Name: Building:
Property Address:
Ed
°L L Jl S pG' S'T
Property is located in a;Conservation Area Y/N Historic Ois W Y/N
2.0 OWNERSHIP INFORMATION
2.1 Owner of Land
Name: -
t Address:
s
23 BE6 KL-r
a
LiGiepEiL p
F
3.0 COMPLETE THIS SECTION FOR WORK IN FYISXING
BUILDINGS ONLY
s 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
" BrW Description of Proposed Work:
Mail Permit to:
What is the currrent use of the Building?
Material of u n If dwelling,how many units?�—
Asbestos?
Will the Building Conform to Law?
Architects Name
Address and Phone
� t � � �N (�
Mechanle s Name /1o�!
Address and Phone�--7� /yJf
i y//U�� C
Construction Supervisors License# D Ff U HIC Reglstration
Estimated Cost of Project 5 PermR Fee Cak ulslion
Permit Fee$ O U Estimated Cost X$7/i1000 Residential
Estimated Cost X$I Ij$I0o0 Commercial
An Additional$5.00 is added as an
Administrative charge.
Make sure that all fields are property 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 %�►
Date
I
N
N u�
i y 01
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0
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