8 CURTIS ST - BUILDING PERMIT APP 1_'lIAA hIIIyt•lil] �II(III � �vi:! ll,AIvp,-Alil �I fPn�`I-II
DEPARTMFNT
Y
APPLICATION FOR PLAN EXAMINATION AND
BUILDING PERMIT
ALL BUILDINGS EXCEPT ONE AND 2 FAMILY DWELLINGS
1:11PORTANT: A licanls must complete all items on this to gr
SlTId INFORMATION
Location Name G 4-urz-Ir1S Building
Property Address " .
Located in: Conservation Area Y/N ARV Historic district '.
APPLICATION DATE
Use Groups
(check one)
Group Humes 113114
Residential (3 or more Units) R2 "),1[70
Type of improvement -Residential (hotel/motel) RI _
(check one) Assembly (Theaters) Al —
New Building_ Assembly (restaurants & clubs) A2r_A2nc
Addition Assembly (churches) Al _
Alteration Business B_
Repaid Replacement Educational E_
Demolition Factory(moderate hazard) Fl _
Move/Relocate Factory(low hazard) F2_
Foundation Only High Hazard H_
Accessory Building Institutional (residential care) Il _
Institutional (incapacitated) 12_
Institutional (restrained) 13
Mercantile M_
Storage Sl _Moderate Hazard
Storage S2 _Low I lizard
0%%NERS11111 INFORMATION(Please type or Print Clearly)
OWNER Name `b GUt -nI"> ST. C-04PO NcsieoVi.
Address X'My. OMT}+7 6Tnr'C4<a-9—
Telephone T716^ -Wft
Signature
DESCRIPTION OF WORK TO BE PERFORMED
I-EM OUe EX IV l l tUb Lt-/W f AIZO S
1•:NT1\I:\I ED CONS"1'RUCTION COS o
r
I.ON1 RA(`IOR INI-ORNIA'1'ION
Name — /XiUY31�
Address !ei �3fNiYhLT 9VC-
Telephone
Construction Supervisor's Lic #
Home Improvement Contractor#
:\RCIIH FCF/ENGINEER INFORMATION
Name
Address
Telephone
Mass. Registration #
PERiIN IT FEE CALCULATION
Estimated Cost x $11/$1,000 + $5.00= �_
CONINIENTS `
The undersigned applicant does hereby attest that all information stated above is trite to the best of my knowledge
under the penalties of perjury
Signed (owner) (ague)
APPROVED 13Y :
—!:=��—
DATE APPROVED: