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39R CLARK ST - BUILDING INSPECTION 7-`Cn) 3 What is the current use of the Building? M III G c*aterial of Building?. InJ c o,� If dwelling, how many units? ,c-�. iZ4 Will the Building Conform to Law? Asbestos? �� � 9 , Archltect's Name Address and Phone ( ) Mechanic's Name Address and Phone *3 j. Jo,.¢sry �.✓ C���e /jj X& .�d�e�✓ Construction Supervisors License# C 5 0 3$,)d) HIC Registration# Estimated Cost of Project$ 1 D ooQ Permit Fee Calculation Permit Fee sf .d 5 en Estimated Cost X$7/$1000 Residential c; a 0 Estimated Cost X$11/$1000 Commercial An Additional $5.06 is added as an o Administrative charge. y 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 e 7 � N a F' 'ate o� C7 u � Crry op sAuu PUBLIC PROPBBIY + DEPAitT ENT Consbvedos DA rb Dfspesal Affidswit ow""6 d a�evudo..e� - I ads �,000edreo..dts�.hdt.dde.adib�ser.soualedco�,7te C1id uado.ltt.! Dobd�ad dr pevt+laar adttKi,s 14 t�1 tr.+dt N �i�•rhL dr aoedtks ttdt dr d�bk ewtdee•os W„ drll l�d good WAS�eo�ly ll��i vaMo dt'a�i A d�Aar blr!/0.• Z�di�brb wW b� TT firs RIKS�n /i�(JdSCA, ��C(llt�s The debut will be disyowd odie: ,l�u oS�cef i �L EI`I Y-OFS-ALEM -- PUBLIC PROPERTY DEPARTIMENT KIN13Fa1.EY DRINAHl ' MAYOR 120 WASHINGrON S'rRFEr*c•LhK MASSACHLSEI-M 01970 TEL-978-74S-959S 1 FAX 976-740-99" 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: 31T P. C-(ckr S Building: �� �(l �fo ,tom Property Address: L cLir 34. Properly is located in a;conservation Area Y/N - Historic District Y/N AI — 2.0 OWNERSHIP INFORMATION 2.1 Owner of Land L J)�anne 1 R�1a nJelsco Ale, z2— ! 3.0 COMPLETE THIS SECTION FOR WORK IN EXISTING BUILDINGS ONLY Addition !u0 Existing On e Renovation �S Number of Stories Renovated d Change in Use Ni) New Demolition Q f Existing Approximate year of Area per floor (sn Renovated construction or renovation of existing building New and Description of Proposed Work: p I Nw W o0F Sl ��,/!L', `ir'Ici l.Gf.'rlc�ou✓�.i. ��.,vvl�yi�1LI ��2�'tffCtl� Mail Permit to: P 50ti eyor y ©1Q16—