14 COLUMBUS AVE - BUILDING PERMIT APP (002) EI`I'Y FSALE --
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PUBLIC PROPERTY
DEPARTMENT
KI NNFM.EY DRISCOLL
MAYOR 120 WASHINGTON STREET SAILli1,HA.ISACHI:SElTS 01970
1'F1i 978-745-959S 1 FAx:97&740.98"
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: /y 6VI"., huf �fcn
Property is located in a; Conservation Area Y/N_&/ —Historic District Y/N Al
2.0 OWNERSHIP INFORMATION
2.1 Owner of Land o�M G-
Name: Y L- ✓<�'
Address:
_ s4 4h. �
Telephone: 9 V- 7-y/- -7ztV4(
3.0 COMPLETE THIS SECTION FOR WORK IN FYISTtNr= BUILDINGS ONLY
Addition Existing
Renovation Number of Stories Renovated
Change in Use New
Demolition Existing
Approximate year of Area per floor (sf Renovated
construction or renovation G
of existing building l�J New
Brief Description of Proposed Work: 1 1 ( /
Mail Permit to:
f y �
What is the current use of the Building? /fir
Material of Building? if dwelling, how many units?
Will the Building Conform to Law? Asbestos?
Architect's Name
Addres and Phone
IVZ Name
Address and Phone
3
Construction Supervisors License# CS o 3 z 7rLv HIC Registration# � 3 y 9 5
Estimated Cost
�of'Project$ J-00" Permit Fee Calculation
Permit Fee $ z _ 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
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