128 BOSTON ST - BPA-07-511 ROOF PUBLIC PROPERTY
04 J^
- UO DEPARTbIENT
Y:I\WFaI.EY DRISIOLL �fY � ((\\``
MAYOR `+ J I20 WASHINGTON$THFEr 0 SALXK VA.%UUa'SL1-M 01970
'lEL'978-745-959S 0 FAx:978-740.9646
APPLICATION FOR THE REPAIR, RENOVATION. CONSTRUCTION. v
DEMOLITION OR CHANGE OF USE OR OCCUPANCY, FOR ANY EXISTING
STRUCTURE OR BUILDING
EProperty
TE INFORMATION
on Name: oS�� Sr Building:
Address: Ste^ e
Sa- ,P_m, to OtOt-70
property is tocated in a;conservation Area 1 R Historic District Y
2.0 OWNERSHIP INFORMATION
2.1 Owner of Land _
Name: /{2 r;to ¢ G'onrdo T+ H S r
Address: t Z g .c3osroA r S1
Telephone:
3.0 COMPLETE THIS SECTION FOR WORK IN EXISTING BUILDINGS ONLY
Addition Existing
Renovation Number of Stories Renovated
Change in Use New
Demolition Existing
Approximate year of Area per floor (sf) Renovated
construction or renovation
of existing building New
Brief Description of Proposed Work:
S P f'-eroof
Mail Permit to:
T
What is the current use of the Building? r--e S;J eAJ T'Pa ( C n&rCQO
Material of Building? Wood If dwelling. how many units? z
Will the Building Conform to Law? Asbestos? +mod
Architect's Name
Address and Phone
Mechanic's Name A • C_ CorSTI.2 C-C- z
Address and Phone 4 L .A-( k-er &&k je2 AS£d X„ ✓''l4 O 1ct <.O
Construction Supervisors License# 054815 a HIC Registration# 1/ 78410
Estimated Cost of Project$ �� �, Permit Fee Calculation
Permit Fee$ Estimated Cost X$7/$1000 Residential
Estimated Cost X$11/$1000 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 to build to the above stated
specifications. Signed under penalty of perjury
Date
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