3 CHASE ST - BUILDING PERMIT APP - EITy-o"'- EIti _-
1 PUBLIC PROPERTY
DEPARTNIE,�tT
�Gvol 130 WUMN arm N17tFi�T•WhK MAMACKLShl-M 01970
TEL-97674S-9S"•IrAx 97&740.9M4
APPLICATION FOR THE REPAIR. RENOVATION CONSTRUCTION
DEMOLITION, OR CHANGE OF USE OR OCCUPANCY FOR ANY EXISTING,
STRUCTURE OR BUMDING
1.0 SITE INFORMATION
Location Name: Building:
----
- Property sr. - --- -____ - --- ----- -- ----- -
3
Property[a located In a;Conservation Area Y/N Historic District YIN
2.0 OWNERSHIP INFORMATION
2.1 Owner of Land c4 I p h 4 Teresa
Name:
Address: 3 C�14J S`t
Telephone: q 7 8- � `{ - (v
3.000MPLETE THIS SECTION FOR WORK IN iNTING BUILDINGS ONLY
Addition Existing a
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:
Mail Permit to:
What is the current use of the Building?
Sid,e-s��lc� Z -��.•..�Y • .. -
Material of Building? `'i Oa 3 lf dwelling,how many units?- —
WIU the Building Conform to Law?
Asbestos?
Architect's Name
Address and Phone , Gt6^
Mechanles Name I U A O Eie
,
cn�
2 t}m 1�-53i-53 EG
Address and Phone I y S/ i 7
Consin.wOM Supervisors License# O335 3a HIC Registration#
Estimated Cost of Project S a 5,o a-0 PertnN Fee Calwlation
I G— Estimated Cost X$71$1000 Residential
Permit Fes i
Estimated Cost X$111$1000 Commercial---- -- -
An Additional $5.00 is added as an
Administrable 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 y 3 d 7
N
v'
N
O \
Wn
E- NL � av y
s
Q �