15-17 BOSTON ST - BPA-2007-371 CITY--0F g —
PUBLIC PROPERTY
DEPARTMENT
NAvot 13D WASmNGTnN b1UEEr SALkj4%initaatLsh-,-Is 01970
10--978-745-11M 0 PAX'975.740-96I6
APPLICATION FOR THE REPAIR RENOVATION CONSTRUCTION
DEMOLITION OR CHANGE OF USE OR OCCUPANCY FOR ANY EXISTING
STRUCTURE OR BUILDING
1.0 SITE INFORMATION %�Fz carp/E / f> - -
Location Name: IS -I ? S4- �dd A-,s r,, Building:
Property Address:
Is— r7 ' z� . Sale Miss
Property is located in a; Conservation Area YIN Historic District YIN
2.0 OWNERSHIP INFORMATION
2.1 Owner of Land `
Name: 3� — S� J O AN IV,
Address:
5- 17 3usEo SF So-(ew� Nt.sS oI970
s
Telephone: 978-
3.0 COMPLETE THIS SECTION FOR WORK IN EXISTING BUILDINGS ONLY
Addition Existing
Renovation TNumbertories Renovated
Change in Use New
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: IS-I 7-.&osj, — S-k 1 (v,,.rs
w
What is the current use of the Building?
W if dwelling.how many units?
Material of Building? '�---
Asbestos?
WIN the Building Conform to Law?
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Architect's Name ( )
Address and Phone
Mechanic's Name j `S-�'•• a�
Address and Phone Fo . Qo>` "7
Construction Supervisors License# HIC Registration#
Estimated Coat o act$ �o oo.— Permit Fee Cak:ulation
Permit Fee s_ Estimated Cost X$71$1000 Residential
Estimated Cost X$"/$1000 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 !�
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