36 BUENA VISTA AVE - BPA-2007-43 t
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' PUBLIC PROPERTY
DEPARTMENT
KIMBMEY DRISCOLL
MAYOR M WAWNGTON STREET•SALEK WL SACHLSEM 01970
TEL 978-745-9595 ♦ FAX:978-740-9W
APPLICATION FOR THE REPAIR, RENOVATION, CONSTRUCTION,
DEMOLITION OR CHANGE OF USE OR OCCUPANCY, FOR ANY EXISTING
STRUCTURE OR BUILDING
1.0 SITE INFORMATION
Location Name: ,';,( Bt)00VW_ V;-b4__Pt1,o_ Building:
Property Address:
Property is located in a: Conservation Area Y/N !/ Historic District Y/N
2.0 OWNERSHIP INFORMATION
2.1 Owner of Land
Name: W�\�-/{121ihL ( Apfwan
I
Address: 31P 13Ur'nLZ. M t S1 _ I/l,.o. �.Y.LI LpM
Telephone: 4 y�- 3�s n rL
3.0 COMPLETE THIS SECTION FOR WORK IN EXISTING BUILDINGS ONLY
Addition g 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
/Bripf Description of Proposed Work:
4,Cce-rs
Mail Permit to:
i
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What is the current use of the Building?
Material of Building? 00&73 If dwelling, how many units? �
Will the Building Conform to Law? Asbestos? =2W
Architect's Name
Address and Phone ( )
Mechanic's Name
Address and Phone
Construction Supervisors License# e��p HIC Registration#
Estimated Cost of Project$ bb J 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 /� lG//Lfiir�/ 07 yY1C It .`
Date
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