136 FEDERAL ST - BUILDING INSPECTION CITY-OFgXLEM -
PUBLIC PROPERTY
DEPARTMENT
MAYOR 130 W.wuncrc N h MEET•
5LkAk%(..ssAaust„s o1970
TEL 976-745.95"*FA :97&740.96"
APPLICATION FOR THE REPAIR. RENOVATION, CONSTRUCTION.
DEMOLITION. OR CHANGE OF USE OR OCCUPANCY, FOR ANY EXISTING
STRUCTURE OR WELDING
1.0 SITE INFORMATION
Location Name: Building:
Property Address-. />G ed s 7`
e e /-�e �
Property Is located in a: Conservation Area Y/N Historic District YIN
2.0 OWNERSHIP INFORMATION
2.1 Owner of Land
Name: ar' W�6� —r
Address:
S�
Telephone: / c� _ S` �- t-! L
3.0 COMPLETE THIS SECTION FOR WORK IN EXISTING BUILDINGS ONLY
Addition Existing
Renovation Number of Stories Renovated
Change in Use a New
Demolition Existing
Approximate year of Area per floor (sf) Renovated +�
construction or renovation
of existing building New
Brief Description of Proposed Work:
Qefn6vt Old C—ablLvt- IV5I / Z6 Net.-
Mail Permit to: /( �'/�9< (/T.
What is the current use of the Building? Re nr 1
Material of Building? i If dwelling, how many units?
Will the Building Conform to Law? Asbestos?
Architect's Name
Address and Phone
Machanies Name
Address and Phone S�! p C s a n S t rh r, !�?
p o �
Construction Supervisors License# > S 6 HIC Registration# /
Estimated Cost of Project S oa, o° Permit Fee Calculation
Permit Fee i Estimated Cost X$7/$1000 Residential
Estimated Cost X$11/111000 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
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