105-107 ESSEX ST - BUILDING PERMIT APP CITY-BF SAL �-
,37 PUBLIC PROPERTY
f DEPARTMENT Q
KINIHFeL EY ORACULL
MAYOR 12D WASHINCMN SrREEr•C"LEK MAhsAcHtsLi-m 01970
'ML,978-745-MS• FAX 978-740-9&M
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: /0, - /d Building:
Property Address: /,5_ Sa /P�
Properly is located in a; Conservation Area YIN Historic District Y/N
2.0 OWNERSHIP INFORMATION (/N/DN Sf• eq A do 5 5
2.4 Owner of Land X!
Name: G yipN 5 f • �n��O 5 5.
Address:
/a 7 SPy Sf .fit/--v. .•�/�V
Telephone: 7 — 2,5— 147 5F
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
add Description of Proposed Work:
----------- Mail Permit to: _ _
c
C' on�rM2rc� a / � /�� S'
What is the current use of the Building? -
Material of Building? ��/c Y if dwelling, how many units?
Will the Building Conform to Law?
c S Asbestos?
Architect's Name ��
Address and Phone t
Mechanic's Name
Address and Phone : fZ/
Construction Supervisors License# /2 7S5S HIC Registration# Z, �SS�
Estimated Cost of Project$ oe Permit Fee Calculation
Permit Fee$2f a 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
d u� 96