28 BECKET ST - BUILDING INSPECTION CrrroF-SALEm --
PUBLIC PROPERTY
DEPARTMENT
1:MOW-R14Y pig ULL Q
MAYM 120 WASWNG am snLEET•SNry,MAYSAQfl:5tllS 01970
Tm 97&74S-9S"*FAX 976740.9846
APPLICATION FOR THE REPAIR. RENOVATION, CONSTRUCTION.
DEtitOLITION. OR CHANGE OF USE OR OCCUPANCY, FOR ANY EXISTING
STRUCTURE OR BUILDING
1.0 SITE INFORMATION
Location Name: D G`►'f I"� Building:
Property-Address— — --- --
c7 17 16 Pei(F� -s /,�,FS
Property Is located In a.Conservation Area Y/N Historic District Y/N
2.0 OWNERSHIP INFORMATION
2.1 Owner of Land
Name: IcGAin e 10 Wzy"k-
Address:
CZ 8 B C' h Sa .�
Telephone: — 7 _ /vy
40
3.0 COMPLETE THIS SECTION FOR WORK IN EXISTING 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 I New
Brad Description of Proposed Work:
P,n h2e. Qoof +
---Mail Permit to: ,9/ Vr f?on g 5. - L.yr»
r s .
What is the current use of the Building?
dw-e�&?y -
Material of Building? If dwelling. how many units?�
Will the Building Conform to Law? Asbestos?
Architect's Name
Address and Phone �
Mechanics Name r Y
Address and Phone iea�{ �v""
Construction Supervisors License# HIC Registration#
Estimated Cost of Project$
r Permit Fee Calculation
Permit Fee$ y� - Estimated Cost X$71$1000 Residential
Estimated Cost X$11/t1000 Commercial -- ---- -- -
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 Permit build to the above stated
specifications. Signed under penalty of perjury
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Date Z 7y
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