5 FAIRFIELD ST - BUILDING PERMIT APP - EITY-MS-ALE
PUBLIC PROPERTY
DEPARTMENT
F:1 M47FRLEY DRIS(:011 7
MAYOR 120 WASHINGTON STREET•SAL EM,X%SSACHLSL:11S 01970
T1Ft•978-745.9S9S • FAX 978-7.10-9U6
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: Building:
Property Address: 6- r )�
Property is located in a; Conservation Area Y/N IV Historic District Y/N
2.0 OWNERSHIP INFORMATION
2.1 Owner of Land
Name: Q
Address: 6-
Telephone: !1 r
3.0 COMPLETE THIS SECTION FOR WORK IN EXISI NG 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 ropo
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Mail Permit to:
What is the current use of�h�eDBy�ildi g?
Material of Building? UV If dwelling, how many units?
Will the Building Conform to Law4 Asbestos?
Architect's Name
Address and Phone l
Mechanic's Name
Address and Phone
Construction Supervisors License# 6 HIC Registration#
Estimated Cost.Of Project$ 1 Permit Fee Calculation
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 ab v tate
specifi ations. Signed under penalty of perjury X. r/
Date
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