100 COLBY ST - BUILDING PERMIT APP r r ' erry-OF-SAL
PUBLIC PROPERTY
L -a7 DEPARTMENT J / (f� � �-7
I:I�MF.RLEY DRISc:O
.MAYOR 120 WASHINCTON STREET♦ $AtEa.`r.\tiSACHlSEIIS 01970 q..
978-745-9595 4 FAx:978-740-9846
APPLICATION FOR THE REPAIR, RENOVATION, CONSTRUCTION,
DEMOLITION, OR CHANGE OF USE OR OCCUPANCY, FOR ANY EXISTING
STRUCTURE OR BUILDING
1.0 SITE INFORMATION
Location Name: `may. ��� S�.. Building:
Property Address:
Property is located in a; Conservation Area YIN Historic District Y/N
2.0 OWNERSHIP INFORMATION
2.1 Owner of Land F
Name: ce-Vq 4 al tL lie A(Z4e_ day i
Address:
«v,
Telephone:
3.0 COMPLETE THIS SECTION FOR WORK IN EXISTING BUILDINGS ONLY
Addition Existing
Renovation V/y L S��.� Number of Stories Renovated
Change in Use New
Demolitia:- Existing
Approximate year of Area per floor (sf) Renovated
construction or renovation
of existing building New
Brief Description of Proposed Work:
Mail Permit to: � r Q �6 o.,.r,+2 % �idv2ir 7/, 019�-�
What is the current use of the Building?
Material of Building? If dwelling, how many units?
Will the Building Conform to Law? Asbestos? JL o
Architect's Name w �
o
Address and Phone 3
Mechanic's Name ��+` ��/2✓ _ _
Address and Phone 5� �^���+''� `
Construction Supervisors License# HIC Registration#
Estimated Cost of Project$_?PO-e. orr-' Permit Fee Calculation
Permit Fee $ f 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 / .
Date
v �y
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