26 BECKET ST - BPA-2009-37 REPAIR ROOF & DECK Crl,y oi
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120A vIMM,i I'N TIItIJ.I * J\l I.LI,A I I I>1 1 0 9-"
11 J:9-8 15 9i')5 * I \\ ')-$ -1,1-')8 1(,
APPLICATION FOR PLAN EXAMINATION AND
BUILDING PERMIT
1, 13U I LDINGS EXCEPT ONE AND 2 FAMILY DWELLINGS
IMPORTANT: %pplicants must complete all items on this page
SITE' INFORMA'fION -- 11 -
Location Name Building
Properly Address 'W 3
Located in: Conservation Area Y/N Historic district
APPLICATION DATE
Use Groups
(check one)
Group Homes R3 114
Residential (3 or more Units) R2
Type of improvement Residential (hotel/motel) RI
(check one) Assembly (Theaters) At_
New Building Assembly (restaurants & clubs) A2r_A2nc
Addition Assembly (churches) At_
Alteration Business B
Repair/Replacement X— Educational E
Demolition Factory (moderate hazard) F1 _
Move/Relocate Factory(low hazard) F2—Foundation Only High Hazard I]
Accessory Building Institutional (residential care) 11 —
Institutional (incapacitated) 12_
Institutional (restrained) 13
Mercantile N1
Storage S1 _Moderate Hazard
Storage S2-1-o\% I Lazard
OWNERSHIP INFORMATION(Please tvpeor Print Clearly)
OWNER Name /t'1.I—L 4 rL
Address—
Telephone
Signature
DESCRIPTION OF IVORKTO BE PERFORMED PIZ �f� 96,0 T--
4-
FS ITNIATED CONSTRUCTION COST e.,. 0 Q
r
CONTRACTOR INFORMATION
Name
Address»� �Y,_MA 1-iJ G rho a S00kf
Telephone '1-78 533k SD3tj
Construction Supervisor's Lic # 9,-4-7 L3
Home Improvement Contractor# / o o g 11
:%RCIIITEUIVENGINEER INFORNIATION
Name
Address
Telephone
Mass. Registration #
PERM T FEE CALCULATION
Estimated Cost x $11/$1,000 + $5.00=
CONINIENI'S -
The undersigned applicant does hereby attest that all information stated above is true to the best of my knoivledge
under the penalties of�p-eerrjury
Signed t_/V v—� �" � _(owner) ( 1�_ent
APPROVED BY : 4a
DATE APPROVED: L� t/ (/ O b