11 ENGLISH ST - BUILDING PERMIT APP Ear-O' g��
PUBLIC PROPERTY
DEPART11dE.�iT
KI\ncn cv DRISCOLL
MAYOR
-MASSAQlCSlI'IS 01970
lh:976741.9S"•FAX 97&740.""
APPLICATION FOR THE REPAIR.RENOVATION CONSTRUCTION
DEMOLITION, OR CHANGE OF USE OR OCCUPANCY FOR ANY EXISTING
STRUCTURE OR BUILDING
1.0 SITE INFORMATION
Locadw Name: CY)65701,C ics5f9GL !�,r�� Building:
_ Property Address:-- - -- - —
Property Is located in a:Conservadon Ares YIN Historic District Y/N e�l
2.0 OWNERSHIP INFORMATION
2.1 Owner of Land
Name: `1XI5T/,v/= (�,!�
Address: /l 13-1z"6LL57,s1 5 7—
Telephone:
3.0 COMPLETE THIS SECTION FOR WORK IN FYIS3TING BUILDINGS ONLY
Addition rExisfingl
Renovation Number of Stories
Change in Use Demolition Approximate year of Area per floor (SO construction or renovation
of existing building
tine[Description of Proposed Work:
f /a
— Mail Permit to: - _
What is the current use of the Building? if dwelling.how many units? 3 —
Material of Building?
� ✓'� Asbestos?
WIN the Building Conform fo to Law? l—
Architect's Name •trn mac•✓ �•-� 7`L 2�[p7
Address and
Mechanie's Name
Address and Phone b HIC Registration tf —
Construction Supervisors License fi
Estimated Cost lea Sf —� Par"Fee Cat elation
Permit Fee i� Estimated Cost X$7fsl000 Residential
------- -- . - Estimated Cost X$I1/$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 '0 ;ell
jy MM
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