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48 CLARK ST - BUILDING INSPECTION (2) _; -- ---- - CITY-OF&ALETNI - - PUBLIC PROPERTY DEPART-144ENT KI]OIFIIEY Dnvu t MAYae 130 WAmumc rm hmm SAIYx.MASSAO/lSh'1lS 01970 741979-745-9S" •FAm 973-740-9646 APPLICATION FOR THE REPAIR. RENOVATION, CONSTRUCTION% DEMOLITION, OR CHA,'YGE OF USE OR OCCUPANCY, FOR ANY EXISTING STRUCTURE OR BUILDING 1.0 SITE INFORMATION Location Name: Building: Property Address: ►i c6 Caw�- f}. Property Is located in a; Conservation Area Y Hlatorie Dbtrid Y© 2.0 OWNERSHIP INFORMATION 2.1 Owner of Land Name: ffsqm e a 1 r Address: L( q C�a.� 0 Telephone: 3.0 COMPLETE THIS SECTION FOR WORK IN "i8IIMG BUILDINGS ONLY Addition Existing Renovation Number of Stories Renovated Change in Use New Demolition Existing Approximate year of a per floor (sf) Renovated construction or renovation I 1 of existing building New Mel!Description of Proposed Work: -- Mail Permit to: _--- _—_ — - - What is the current use of the Building? „F Material of Building? it dwelling.how many units?_ 5 C Will the Building Conform to Law? �ro Asbestos? o Architect's Name Address and Phone Mecharnles Name E `�'�° ►ZfsU S6"1 Address and Phone Constriction Supervisors Lice >+ CS 21�G HIC Registration N Estimated Cost f $ d Permit Fee Calculation Permit Fee i Estimated Coat X s7/$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 � — Date 2 0 Q ' N N a _ ,to (� M At v s` w d r a