43 CHESTNUT ST - BUILDING PERMIT APP (002) 67s ay
PUBLIC PROPERTY
DEPt1RT�tE�1T
KI�ME�Y DRISI:UII.
MAYOR 120 WASHING"S MEU•SV`E.MASSArHl:SL1-S 01970
Tts:978-74S-9S9S♦FAx:97&740.9946
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: 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: r
Address: 4?1b
Telephone: %J qie- J` '�/
3.0 COMPLETE THIS SECTION FOR WORK IN EXISTING BUILDINGS ONLY
Addition Existing
Renovation �"{" Number of Stories Renovated
Change in Use New
Demolition Existing
Approximate year of �¢� Area per floor (so Renovated
construction or renovation IV a
of existing building New
Brief Description of Proposed Work:
Mail Permit to: 3
1
What is the current use of he Bu'ding?
rJ
Material of Building? uA^ k if dwelling, how many units?
Will the Building Conform to Law? ✓ Asbestos? Att
Architect's Name
Address and Phone
Mechanic's Name
Address and Phone
Construction Supervisors Licspse# HIC Registration#
Estimated Cost of Project S Permit Fee Calculation yZC
Permit Fee$ Estimated Cost X$7/$1000 Residential S
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 fora BuildingPermit.to uil loth bo e s ad
specifications. Signed under penalty of perjury X
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