4 CHEVAL AVE - BUILDING PERMIT APP EI`I`-HP S hm
PUBLIC PROPERTY
DEPARTMENT
1:1.%6/ERI.EY DIIISI:OLL !�
MAYOR i?0 WASHINGTON STREET -
aAlrau,JtA.ssAcxt;sE,-rs 01970
TEL*978-745-9595*F.Vc 978-740-9846
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 YIN
2.0 OWNERSHIP INFORMATION
2.1 Owner of Land
Name: -jCo lln'51-F6 L 0
Address:
05600o sr. 5AIsw
Telephone: -7,6— — oo
3.0 COMPLETE THIS SECTION FOR WORK IN EXISTING BUILDINGS ONLY
Addition Existing Z
Renovation Number of Stories Renovated S
Change in Use New
Demolition Existing
Approximate year of / Area per floor (sf) Renovated
construction or renovation '/ New
of existing building
Brief Description of Proposed Work:
,Tj!5M1(( W'/97'E/f- 1� 'wtff4�9 Fe—ow-51 Wus CIFC/N65
1N5TIMLL 9tsre> /fl-- / sT
P&IIV7- ,file /V4-W WORK
Mail Permit to:
What is the current use of the Building? 'ESiD£n/C�
Material of Building? w0d o If dwelling, how many units? L
Will the Building Conform to Law? 7E5 Asbestos? NO
Architect's Name
Address and Phone �—
Mechanic's Name
Address and Phone /� S PA/
Construction Supervisors License#C 2,Zie HIC Registration# 3�yg8
Estimated Cost
��oiff,,Project$ Permit Fee Calculation
Permit Fee$1 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 X ` "' t'°
Date 06
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