CORNER OF FERRY STREET AND WAITE STREETS - BUILDING INSPECTION E -
' PUBLIC,PROPERTY
DEPARTMENT �
KI%fism.EY DRISCOLL
MAYOII - 120 WASHINGKIN S"IREEr•SAI EM HA.SSACHI:SLTR 01970 \
TEL-978-745-9595♦FAX:978-740-9M
APPLICATION FOR THE REPAIR RENOVATIONg CONSTRUCTION.
DEMOLITION. OR CHANGE OF USE OR OCCUPANCY, FOR ANY EXISTING
STRUCTURE OR BUILDING
1 A SITE INFORMATION
Location Name: Building:
Property Address: 1 / /
ro?,"&- O� r �/-i'PPT S" -/ P
Property is located in a; Conservatio Area YIN�_ Historic District Y/N V
2.0 OWNERSHIP INFORMATION
2.1 Owner of Land
Name: /Va ar
Address:
Telephone:
3.0 COMPLETE THIS SECTION FOR WORK IN EXISTING 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
of existing building New
Brief Description of roposed Work:
Mail Permit to:
�1
What is the current use of the Building?`.A -)C)Pf Ce Ch T ZV
Material of Building? If dwelling, how many units?
Will the Building Conform to Law? Asbestos?
Architect's Name
Address and Phone
Mechanic's Name 1IL11A xyl�IIiu
Address and Phone ��SO/�usr7�5 I-Pe7L—�'TTSs�i%�
Construction Supervisors License# HIC Registration#
Estimated Cost of Project$ Permit Fee Calculation
Permit Fee$ -15-•0 Estimated Cost X$7/$1000 Residential
s� / Estimated Cost X$11/$1000 Commercial
l '�v4 Afio l V�rC T�/( � An Additional $5.00 is added as an
1pc OJJT / Administrative charge.
�G -AI is x?J'
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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