3 1-2R BUFFUM ST - BPA-2008-30 EIT�O� - -
PUBLIC PROPERTY
DEPr1R'I1biENT
KI%G*J"ORLYOLL
NIAVOR 120 WAWMGRW SntM 0 '
�JA,MASSACHl56ll5O1970
1Ei 972-745.959S R PAZ M740.9W
APPLICATION FOR THE REPAIR. RENOVATION. CONSTRUCTION,
DEMOUTIOX OR CHANGE OF USE OR OCCUPANCY, FOR ANY EXISTING
STRUCTURE OR BUILDING
1.0 SITE INFORMATION J
Location Name: Building:
Property Address:-j >/ -- —
��L 6n'I /Y7R
Property Is boated In a:Conservation Area YIN Historic District YIN
2.0 OWNERSHIP INFORMATION
2.1 Owner of Land
Name: G'OLr ;1)
Address: 31,-;�- i2 Rr✓GFr/r?,? s--r—
Telephone:
3.0 COMPLETE THIS SECTION FOR WORK IN EVIRTING 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
B6et Description of Proposed Work:
/2E�Ude ia-� d
----- --- ------Mail Permit to:
What is the current use of the Building? 5 i` L'i`!KV
Material of Building? , `�— if dwelling.tow many units?____4
WiB the Building Conform to Law? Asbestos?
Architects Name
Address and Phone ( j
Mechanies Name
Address and Phone
Constnution Supervisors License S HIC Registration S
Estimated Cost of Project i �� �® c Pem*Fee Calculation
Permit Fee$� Estimated Cost X$7151000 Residential
.. . . _--- _- -- ---- Estimated Cost X S41/S1000 CwnmOmla4------- -
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 X
Date z o
c� N
CA
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