3C DEWEY DR - BUILDING INSPECTION (3) JACKET ��� q,
;?+ .tka' fi�
0 E t �
11,
n
E
_. . UA':Dk,{r4dd(R' aMUY.I!iYi.>
• ... :yllf .t 'tN�t'prFT !%'1T'U'" :..t ..rf..
JA,I irYd" I , r.rN1• �t +;4�r, •r a1~, ry3C!'4 �990
' ,�:.{!✓; rrtt ';'lJy^ f,:%:fAZi I,il 1'i:�Cb'i! �n17.,. '! y ... � ..
y ,
t 4 r!f {.'.4f)Ya ,i (S:Ua+S ,f.ib'. l,..f'§11f ...,.. l .. r `f � i •�
dvF dF?IQr1` ^
C;:i9,)f;,% ,{:S'' .. . t n�F� .. . d 'f' •1 y3'1� y5+'{tY.;
. tib '{t1!l+ :�12r.3 .'. /}�,.-.r ?!'{ • >31RE�!(v,t�a:rt r:::,ydfY ,ycQt:h��;'".
(y4Y j.:. t Yr.. a r.
� .itid{O q�� 1,"1'�i_ ':.9�� ! s N'} r Y � �i+� �p .1 : f�aq�i ':pvgt?. 8L2�SKt,.Y.,•
...............r
.a {li,' ;}(! .G'i.'. � � �Iri14r}.I ik i tYl�. X! 9,%fr1:'•
LL
J .w6'�rgb8i':
1 t3 yp�
0 W
/ Zfl ♦ £ � 111 m � V+
= s O
E-rL
CL
a cn
Citp Df �&afemr �%5E;arbu5ettE
PLANS MUST BE FILED AND APPROVED BY THE
INSPECTOR PRIOR TO A PERMIT BEING GRANTED
Location of Building ��'
Building Permit Application For:
`(Circle whichever applies) Roof, Reroof, Install Siding,Construct Deck, Shed, Pool
Addition, Alteration, Repair lace,Foundation Only, Wrecking
Other.
PLEASE FILL OUT LEGIBLY & COMPLETELY TO AVOID DELAYS IN PROCESSING
To the Inspector of Buildings:
The undersigned hereby applies for aapermit to build according to the following specifications:
OwnereNsme: /\c�yl ' l J6 Contractor. D�'^r;
Street `j L Al .JeS-I Cit�)g y l Street tC_T
/j� k tY
State � °t Phone ( ) Stater l�M 9i Phone() - 4 a
Architect: City of Sakm Lich 5 a` 110
Street City State lid(), 4 7 S 7HIP II 1 i y d 7
State Phone ( ) Homeowners Esempt/Form__yes_�L_no
Structure: (please circle) Sjngle Family, Multi Family q Other
Estimated Cost of job S 1 DDT
Will building confirm to law?,,,L_ycs no
Asbestos?_ycs •K no /)��� G Description of work to be done:- V` J
Dra ifir ubmitted: yes_ no Mail Permit to:g`r/���
x -
Signature of Application,SIGNED UNDER THE PENALTY OF PERJURY
CONSTRUCTION TO BE,COMPLETED WITHIN SIX(6)MONTHS OF PERMIT ISSUED DATE
Department use only: Permk'11\��`� ning Map/Lot_T_
Permit fee;
COMMMS: \���\
Erry-O
PUBUC PROPERTY
-a° I6pz DEI'ARTI4I NT
M:�raa �191�—�/� t30WwsHtawlcw-ScxehTs,�ry,wssnaasE,-is01970
. 1FL•:97CTii9S9S�F�7C 921=yi0-9116
APPLICATION FORTMAEPAIR.RENOVATION.CONSTRUCTION.
DEMOLITION. OR CHANGE.OF irSE QR:OCCUPANCY..FOR ANY.E CIS'I'IrTG
�STRUCTURE..OR.BUILDING
1.0 SITE VQti
P►cpe►tYKddress`— UGC ,�a?'`l
Property is WW"d`in a;Coniservation;N res YM Historic Qlatrlit Y/N'
2G0OWNERSHIP`'INFOR' SON
21 Owner of Land
Name: _, ./1 ci Cel^n(kf
Address:
Telephone:
-
3 o COMPLETE TH18 SECTION-FOKWORK IN EIUMUG t3UILDINGB`ONLY
Addition Existing.
Renovation Number of Storles Renovated'
Change in'Utte NeW
Demolition sting ,
Approximate-year of I Area per floor (
sf) Renovated
construction or renovation
rEkij
existing building New
t Description of Proposed Work:
P Ire cv jI. even ok �lVlce�c o
0 sit
-
Mail Pertnit•to: (� �revvt. ®2I
maiewotuse tl�s t3iNdSp?
VViYifs�
Ar °a
Addmw4WPhWW
Coross+ ate 9up�rve+s U aN . .,., ._.� •.,AN •—
ar�°�Ost of Punt�6 -�
A swm-mat all wo pm iteny mhd 9 z 6 8vatd !�
7'Pwf undasigrsd !doh temby qu4d%VWire
sta1
sp,�c,�u®rs.: ssct.unda�pmrs�v� t
i
i
w y
What is the current use of the Building?
Material of Building? K dwelling.how many units?_�--
Will the Building
Conform to Laval) Asbestos?
Archited's Name ( 1
Address and Phone
Medw+ie's Name
Address and phone '
Construction Supervisors License g HIC Registration 0lrs9 `1 �/7 S�
Estimated Cost of Projed s.. . Permit Fee Calculation
Permit Fee: Estimated Cod X S71SttX10 Residential
Estimated Cod X S11/S1000 Commercial--._ -
- An Additional$5.00 is added as an
Administrative charge.
Make sure that all flelds are properly and legibly written to avoid delays In prooeseing.
The undersigned does hereby apply for a Building permit to build to the above stated
specftedons. Signed under penalty of perJury x "
Date
o vl
0
N
a
x as
a
4