33 BOARDMAN ST - BPA-2008-776 RECONFIGURE MBR & BATH ClTrOFSALEM
PUBLIC PROPERTY
DEPARTMENT
Mwvaa 130 WAswnarM hh� 9.ury,WxtncHtsci-rs 01970
7419'474S-9S"*FAx:97L740.96"
APPLICATION FOR THE REPAIR RENOVATION, CONSTRUCTION.
DEyiOLITION. OR CHANGE OF USE OR OCCUPANCY, FOR ANY EXISTING
STRUCTURE OR BUILDING
1.0 SITE INFORMATION
Location Name: 33 00arjv"av\ S�ree � Building:
Property Addresr. 3 �00.Vn,A,,a✓X S I 1_� --0 0
Property is located in a; Conservation Area Y Historte DWk*Y
2.0 OWNERSHIP INFORMATION
2.1 Owner of Land _
Name: Ffo(0ert So1Owt0 k-
Address: 3 3 $o ar J rvt a K\ S+v eE?
Telephone: q7Z- 74-o —280
3.0 COMPLETE THIS SECTION FOR WORK IN EXlSI1NQ BUILDINGS ONLY
Addition Existing
Renovation ✓ Number of Stories Renovated t
Change in Use New
Demolition Existing
Approximate year of Area per floor (sn Renovated / 2 Sr
construction or renovation �7S
of existing building New
Brief Description of Proposed Work:
3 a JrGY� c3e �rPow� b y
Mail Permit to: �o�2r��0 6 v�v� 33 T>oaY d Ma v, S'. I Sa. e _ _
What is the current use of the Building? Z
Material of Building? LJu-o If dwelling, how many units?
Wig the Building Conform to Law?�5�-� Asbestos?
✓l o
Architect's Name
Address and Phone ( )
Mechanic's Name
Address and Phone
Construction Supervisors License# HIC Registration 0
Estimated Cost of Project S Permit Fee Calculation
Permit Fee $ 33 � �� Estimated Cost X$7/$1000 Residential
Estimated Cost X$11/i1000 Commercial
An Additional $5.00 is added as an
Administrable 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 to build to the above stated
specifications. Signed under penalty of Pury X ed
Date
oI
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s
V
29 96 J 4