8 BUFFUM ST - BPA-2007-552 CITY OF SALEM
" PUBLIC PROPERTY
/J//��(��JJ DEPARTMENT
KIMBERI.EYDRISCOII. �l�/(�/ OI
MAYOR c 120 WASHINOTON SR1EEr♦ SALEm,,,NGI.SSACHu.sm-N 01970
Ili 978-745-9595♦ FAx:978-740-9846
APPLICATION FOR THE REPAIR9RENOVATION;,CONSTRUCTION,
DEMOLITION OR CHANGE OF USE OR OCCUPANCY, FOR ANY EXISTING
STRUCTURE OR BUILDING`
1.0 SITE INFORMATION _
Location Name: 13u�- i ,S+ Building: g
Proq" Address:
1JLC �h _ 54-
Property is located in a; Conservation Area Y/N tJ Historic District Y/N
2.0 OWNERSHIP INFORMATION
2.1 Owner of Land _
Name: .4 1ve$3 MC 62f4-mw-
Address: g , /T L.� Cc-(-FA- �7
Telephone: 7 7 /Z
3.0 COMPLETE THIS SECTION FOR WORK IN EXISTING BUILDINGS ONLY
Addition Existing
Renovation Number of Stories Renovated
Change in Use New
Demolition Existing j49-v/�I
Approximate year of Area per floor (sf) Renovated
construction or renovation
of existing building New
Brief Description of Proposed Work:
-GrUS7 wIvy� S1411u� Qju(�-
22(�}�.z� TiQdwl Cllo-7-r.�z dec%<a,� c�n��- R�•..I•/S GN /s7��/ovz
paa
Mail Permit to: P9NeS3 Ne U/9 7U
I� 1
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What is the current use of the Building?
Material of Building? W M� If dwelling, how many units?
Will the Building Conform to Law? Asbestos? Nd
Architect's Name
Address and Phone )
WOODY HUiviL iPROVEMEW
Mechanic's Name »}1 (�6EARANT ST -
Address and Phone WENHAW MA 01984 gt-3-y 6$,�13 Z2
Construction Supervisors License# U�$�62�/ HIC.Registration # /0 51
Estimated Cost of Project Permit Fee Calculation
Permit Fee $ Alin) 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 too the
Babove
/stated
specifications. Signed under penalty of perjury
Date lZ �66
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