140 BRIDGE ST - BUILDING PERMIT APP (002) PUBLIC PROPERTY
DEPARTMENT
AIMBMEY DNISCOLL
MAYOR
i?0 WASHINGTON S'TREEr#SAS uu ,M&ALSAQiLStXts 01970
TEL 978-745-9595 #FAx 978.740-98"
APPLICATION FOR THE REPAIR, RENOVATION CONSTRUCTION
DEMOLITION, OR CHANGE OF USE OR OCCUPANCY FOR ANY EXISTING
STRUCTURE OR BUILDING
1.0 SITE INFORMATION o
Location Name: / Ll O Gr1 5t Building:
Property Address: Or, �r
_SALeAj � lg7a
Property is located in a; Conservation Area Y/N "J Historic District Y/N
2.0 OWNERSHIP INFORMATION
2.1 Owner of Land
Name: T t—�Je Sri t j l;
Address: ( 'l o
SQq ev� P DC -2 -0
Telephone: 2--
3.0 COMPLETE THIS SECTION FOR WORK IN EXISTING BUILDINGS ONLY
Addition Existing 3
Renovation Number of Stories Renovated
Change in Use New
Demolition Existing jp
Approximate year of Area per floor (so Renovated
construction or renovation
of existing building g New
Brief Description of Proposed Work: 4 ,t
`' �AAAcQrws
Mail Permit to: t' aZ t c �(
What is the current use of the Building? —
Material of Building? If dwelling,how many units?
Will the Building Conform to Law? Asbestos?
Architect's Name
Address and Phone
Mechanic's Name �' !��Q "
Address and Phone
1u� 4e<�R� rw 5 — A
Construction Supervisors License# ®_ l T HIC Registration#
Estimated Cost of Project$�6 6 Oo 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 bull o e ab ve sta d
specifications. Signed under penalty of perjury /�
Date
KIN
N 1�
4Oi1 O•?
v� d
a u� 6 G6 a