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32 CABOT STREET - BUILDING JACKET No. ,s3L.2 HASTINGS. MN LOS ANGELES-CHICAGO-LOGAN.OH MCGREGOR.T%-LOCUST GROVE.GA U.S.A. SENDER: COMPLETE THIS SECTION COMPLETE THIS SECTION ON DELIVERY ■ Complete items 1,2,and 3.Also complete A. Signature ...item 4 if Restricted Delivery is desired. D Agent ■ Print your name and address on the reverse X D Addressee s0 that we can return the card to you. S. Received by(Printed Name) C. Date of Deliver, o Attach this card to the back of the mailpiece, or on the front if space permits. 1. Article Addressed to: D. Is delivery address different from Rem 17 D Yes \ , If VES,enter delivery address below: ❑ No 3. Service Type �h l k C-71 ❑wed Mail D Express Mail D Registered D Return Receipt for Merchandise ❑ Insured Mail ❑C.O.D. 4. Restricted Delivery?(Extra Fee) D yes 2. Article Number (Transfer from service label) PS Form 381 February 2004 Domestic Return Receipt 102595-02-M-1540 1 I 1 it if Ili I II II II 111 1 r I UNITED STATES POSTAL SERVICE First-Class Mail Postage&Fees Paid USPS Permit No.G-10 • Sender: Please print your name, address, and ZIP+4 in this box City Of Salem Building Department 120 Washington Street Salem, MA 91979 2TOL CITY .01F SALEM, MASSACHUSETTS BUILDING INSPECTOR 120 WASHINGTON STREET, 3RD FLOOR SALEM, MASSACHUSETTS 01970 UNIreo 29fig 2TEE 2000 0fi9T 2TOL NAME Sigfrido Velasquez 32 Cabot Street-Apt. #2 1�es—f IST NOTIC'K7. Salem, Massachusetts 01970 2 IN D 2ND CjTi 72 01/2S/13 TO F UP WA R PEIIT=W RETURN R D" 0- 01970@4642! =1 CITY OF SALEM, MASSACHUSETTS BUILDING DEPARTMENT 120 WASHINGTON STREET,3RDFLOOR TEL: 978-745-9595 FAx: 978-740-9846 KIMBERLEY DRISCOLL MAYOR THOMAS ST.PIERRE DIRECTOR OF PUBLIC PROPERTIES/BUILDING COMMISSIONER REQUIRED INSPECTION NOTICE 32 CABOT STREET January23, 2013 - - Sigfrido Velasquez 32 Cabot Street- Apt. #2 Salem, Massachusetts 01970 Owners, The above referenced property has come to the attention of this department for the following reason(s): A report has been made to this office that there is an illegal third apartment unit located in the 3"d Floor/Attic ofyour building which is located in an R2 Zoning district. Upon investigation on January 17, 2013 the information regarding the alleged unit on the third floor appears to have reasonable validation. For this reason an inspection must be conducted by our office to assure compliance with the code and city ordinance.Additionally there is concern by that heat from one unit is supplying heat to the illegal basement unit and improperly installed, A Required Inspection must be conducted by our Department to assure compliance with the State Building code and city ordinances. Under the provisions of 780 CMR, Section 104.6—Right of Entry, of the State Building Code, access to this property must be granted for the purposes of this inspection. Please call this office upon receipt of this letter, if this property has rental units these tenants must be notified in advance of this inspection so that access to these spaces may also be accomplished. This Required Inspection shall be conducted by this office on Wednesday, January 30, 2013 at 10:00 a.m.; failure to respond to this notification will be construed as non- compliance,with issuance of Municipal tickets and as such an Administrative Search Warrant will be sought, so as to allow the lawful inspection of this property. If you feel you are aggrieved by my zoning interpretation, your Appeal is to the Salem Zoning Board of Appeals. If you feel you are aggrieved by the Building code sections,your Appeal is to the Board of Buildings, Regulations and Standards in Boston. If you have any further questions regarding this letter,please call this o 619-5648. Michael E. Lutrzykowski Assistant Building Inspector cc: file, Health Department,Jason Silva SENDER: DELIVERY ■ Complete items 1,2,and 3.Also complete A. Si�at item 4 if Restricted Delivery is desired. ❑Agent ■ Print your name and address on the reverse X ❑Addressee so that we can return the card to you. B. Received by(Printeff(PrintName Date of Delivery ■ Attach this card to the back of the mailpiece, 2- 2 3 or on the front if space permits. 1. Article Addressed to: D. Is delivery address different from item 1? ❑Yes � i If YES,enter delivery address below: ❑No i �kA6V 'elet-<2, SGIO✓_K_. ^_ 96 3. Service Type / ❑Certifled Mail ❑Express Mail ❑Registered ❑Return Receipt for Merchandise ❑ Insured Mail ❑C.O.D. 4. Restricted Delivery?(F_Mra Fee) ❑Yes 2. Article Number (Transfer from service label PS Form 3811,February 2004 Domestic Return Receipt to25ssaz-m-tsao UNITED STATES F 1&Fe -ty�l .411� . - �Z� :U-.� FEB 2.111)13 F • Sender: Please print your name, address, and ZIP+4 in this box City Of Salem Building Department 120 Washington Street Salem, MA 01970 111h 11iIIII)IJ 1"IrI11111,I)HI Jill aCITY OF SALEM, MASSACHUSETTS BUILDING DEPARTMENT 120 WASHINGTON STREET, 311D FLOOR 'ISL: 978-745-9595 KIMBERLEY DRISCOLL FAx: 978-740-9846 MAYOR THOMAS STYIERRE DIRECTOR OF PUBLIC PROPERTIES/BUILDING COMMISSIONER February 5, 2013 Sigfrido Velasquez 32 Cabot Street- Apt. #2 Salem,Massachusetts 01970 This letter shall serve as notification that all alleged violations and notices stated in our department's January 23,2013, Required Inspection letter are no longer outstanding with this Department. Your property is presently a two (2) family unit residence as required by City Ordinance, and does not contain any separate living units in the third floor at this time. Additionally your first floor unit is a two (2) bedroom as currently arranged as discussed during our inspection. If you have any question please feel free to contact the Building Inspector's Office. Respectfully, Michael E. Lutrzykowski Assistant Building Inspector Cc: file, Jason Silva,Health Department �Q� CITY OF SALEM, MASSACHUSETTS 9 r c BUILDING DEPARTMED 120 WASHINGTON STREET, 3 FLOOR TEL: 978-745-9595 FAx: 978-740-9846 KI N/HIEI2LEY DRISCOLL MAYM THOMAS ST.PIERRE DIRECTOR OF PUBLIC PROPERTIES/BUILDING COMMIISSIONER REQUIRED INSPECTION NOTICE 32 CABOT STREET .lanuary 23,2013 Sigfrido Velasquez 32 Cabot Street- Apt.#2 Salcm,,Massachusetts 01970 Owners, The above referenced property has come to the attention of this department for the following reason(s): A report has been made to this office that there is an illegal third apartment unit located in the 3"r Floor/Attic of your building which is located in an R2 zoning district. Upon investigation on .lanuary 17, 2013 the infio rmation regarding the alleged unit on the third.floor appears to have reasonable validation. For this reason an inspection must be conducted by our office to assure compliance with.the code and city ordinance.Additionally there is concern by that heat from one unit is supplying heat to the illegal basement unit and improperly installed,A Required Inspection must be conducted by our Department to assure compliance with the State Building code and city ordinances. Under the provisions of 780 CMR, Section 104.6—Right of Entry, of the State Building Code, access to this property must be granted for t:he purposes of this inspection. Please call this office upon receipt of this letter, if this property has rental units these tenants must be notified in advance ofthis inspection so that access to these spaces rear also be accomplished. This Required Inspection shall be conducted by this office on ll/ednesdag .lanuary 30, 2013 at 10:00 a.m.; failure to respond to this notification will be construed as non- compliance, with issuance of Municipal tickets and as such an Administrative Search Warrant will be sought, so as to allow the lawful inspection of this property. If you feel you are aggrieved by my zoning interpretation, your Appeal is to the Salem Zoning Board of Appeals. If you feel you are aggrieved by the Building code sections, your Appeal is to the,Board of Buildings, Regulations and Standards in Boston. If you have any further questions reg'a�arrd�ing this letter,please call this office at(978) 619-5648. Michael E. ildin Inspe AssistanT Building Inspector cc: file, Health Department, Jason Silva COPY The Commonwealth of Massachusetts Board of Building Regulations and Standards CITY OF SALEMassachusetts State Building Code, 780 CMR d Reviseed Mar Mar 2011 Building Permit Application To Construct,Repair,Renovate Or Demolish a One-or Two-Family Dwelling This Section For Official Use Only Building Permit Number: D ppli t C� Building Official(Print Name) 01gamine Date SECTION 1: SITE INFORMATION 1.1 Pope Addr, is. 1.2 Assessors Map&Parcel Numbers o t S Re�T 1.1a Is this an accepted street?yes no Map Number Parcel Number 1.3 Zoning Information: 1.4 Property Dimensions: Zoning District Proposed Use Lot Area(sq W) Frontage(ft) 1.5 Building Setbacks(fit) Front Yard Side Yards Rear Yard Required Provided Required Provided Required Provided 1.6 Water Supply: (M.G.L c.40,§54) 1.7 Flood Zone Information: 1.8 Sewage Disposal System: Public❑ Private❑ Zone: _ Outside Flood Zone? Municipal❑ On site disposal system ❑ Check if yesO SECTION 2: PROPERTY OWNERSHIP' 2.1 Owner of Record: iCry �)� V HAS©UCZ S }L +M f -j"Y"-' 11 --- Name(Print) ° City,S:�ce,Zi_^ 3a CpRc-)T sMtVT I? V-4VW No.and Street Telephone Email Address SECTION 3:DESCRIPTION OF PROPOSED WORK'(check all that apply) New Construction❑ Existing Building❑ Owner-Occupied ❑ Repairs(s) J Alteration(s) ❑ Addition ❑ Demolition ❑ Accessory Bldg. ❑ Number of Units Other ❑ Specify: Brief Description of ProposedWorV: -'cettzJ�t E 64 S SRO 6- C- 91TP-r i S rDue t I t T 14 .31r Bw Sk L y SECTION 4: ESTIMATED CONSTRUCTION COSTS Item Estimated Costs: Official Use Only (Labor and Materials 1.Building $ Q go 1. Building Permit Fee: $ Indicate how fee is determined: 2.Electrical $ ❑Standard City/Town Application Fee ❑Total Project Cost(Item 6)x multiplier x - 3.Plumbing $ 2. Other Fees: $ 4.Mechanical (HVAC) $ List: 5.Mechanical (Fire $ Suppression) Total All Fees:$ �/^ GG Check No. Check Amount: Cash Amount: 6.Total Project Cost: $ O� DO� ❑Paid in Full ❑Outstanding Balance Due: C U- ter [� G) SECTION 5: CONSTRUCTION SERVICES 5.1 Construction Supervisor License(CSL) ts7003 i0/6 i3 f License Number Expiration Date Name of CSL Ho der List CSL Type(see below) PG , (3 t taC,f No.and Street Type Description Unrestricted(Buildings up to 35,000 cu.ft.W1 t 1 0 `c& '1 Restricted 1&.2 Family Dwelling City/Town,State,ZIP M Masonry RC Roofing Covering WS Window and Siding n// 7` SF Solid Fuel Bunting Appliances -7oZGf 7oNNQAN1a0x, D /O/VYl/S1%f i Insulation Telephone Email address .Ch D I Demolition 55..22 Registered Home Improvement Contractor(MC) 14//L/9 Z �y, /yy J,h' l N Qfl In fl Qnf HIC Registration Number Expiration Date HI,C Com any Name or HIC Registrant Name P� ocer 1 fI/YOANmPAMD— HoTmci,/, No.and Street Email address 'Ityrr Swno�, fate,ZIP Telephone SECTION 6:WORKERS'COMPENSATION INSURANCE AFFIDAVIT(M.G.L.c.152.§ 25C(6)) Workers Compensation Insurance affidavit must be completed and submitted with this application. Failure to provide this affidavit will result in the denial of the Issuance of the building permit. Signed Affidavit Attached? Yes ..........A No...........❑ SECTION 7a: OWNER AUTHORIZATION TO BE COMPLETED WHEN OWNER'S AGENT OR CONTRACTOR APPLIES FOR BUILDING PERMIT I,as Owner of the subject property,hereby authorize TaH N Q f'fNTA P A J to act on my behalf,in all matters relative to work authorized by th'�building permit application. SLGwPRuNm il$LAsa�ee) �f/,�„ aY / Print Owner's Name(Electronic & -c Signature) f I-AV � Date SECTION 7b:OWNEW OR AUTHORIZED AGENT DECLARATION By entering my name below,I hereby attest under the pains and penalties of perjury that all of the information contained in this application is true ago ace to a best of my knowledge and understanding KN P r /3 Print Owner's or Authorized Agr 's Name(Electronic ignature) Date NOTES: 1. An Owner who obtains a building permit to do his/her own work,or an owner who hires an unregistered contractor (not registered in the Home Improvement Contractor(HIC)Program),will-not have access to the arbitration program or guaranty fund under M.G.L.c. 142A.Other important information on the HIC Program can be found at -v.mass. og v/oca Information on the Construction Supervisor License can be found at www.mass.gov/dps 2. When substantial work is planned,provide the information below: Total floor area(sq.ft.) (including garage,finished basement/attics,decks or porch) Gross living area(sq.ft.) Habitable room count Number of fireplaces Number of bedrooms Number of bathrooms Number of half/baths Type of heating system Number of decks/porches Type of cooling system Enclosed Open 3. "Total Project Square Footage"maybe substituted for"Total Project Cost" The Commonwealth of Massachusetts W Board of Building Regulations and Standards CITY OF Massachusetts State Building Code, 780 CNIR SALEM Revised Mar 2011 Building Permit Application To Construct, Repair, Renovate Or Demolish a One-or Two-Family Dtivelling This Section For'Officiat Use Only. Building Permit Number: Date Applie Building Official(Print Name ''S�gnat Date SECTION 1: SITE INFORMATION 1.1 Property Addres: 1.2 Assessors Map& Parcel Numbers 5 2— Cci90 S I ( ' l.la [s this an accepted street?yes no Map Number Parcel Number 1.3 Zoning Information: 1.4 Property Dimensions: Zoning District Proposed Use Lot Area(sq It) Frontage(ft) 1.5 Building Setbacks (it) Front Yard Side Yards Rear Yard Required Provided Required Provided Required Provided 1.6 Water Supply: (M.G.L c. 40,§ 54) 1.7 Flood Zone Information: 1.8 Sewage Disposal System: Zone: _ Outside Flood Zone? Public ❑ Private❑ Municipal if yes❑ unicipal❑ On site disposal system ❑ SECTION2:, PROPERTY'OWNERSIIIP!' 2. ,,0 i+�r';.ofRecord `Di uf�'1 � � �j2jcescruez SDI , Ole, X Name(Print) City,State,ZIP Z cctbo1 5T AP ll+�3' 6o1 - 6w� No. and Street Telephone Email Address SECTION 3: DESCRIPTION OF PROPOSED WORK=(check all that apply) New Construction ❑ Existing Building❑ Owner-Occupied ❑ Repairs(s) ❑ Alteration(s) ❑ Addition ❑ Demolition ❑ Accessory Bldg. ❑ Number of Units_ Other ❑ Specify: Brief Description of Proposed Work': SECTION 4: ESTIMATED CONSTRUCTION COSTS Estimated Costs: Item Official Use Only%. Labor and Materials 1. Building $ I Building Permit Fee S Indtcaie how fee is determined: �. Electrical $ ❑ Standard City/Town Application Fee ❑Total Project Cost'—(Item 6)x multiplier x 3. Plumbing S 2. Other Fees: $ t Mechanical (FIVAC) S List 3. Mechanical (Fire S Sn� ression) Total All Fees: .S r— Check No. Check:\motmt: Cash Amount 6 Total Project Cost: $ 4j4Qt ❑ Paid in Fall 0 Outstanding Balance Duo: r SECTION 5: CONSTRUCTION SERVICES 5.1 Consttvction Supervisor License(CSL) License Number Expiration Date Name ofCSL Holder List CSL Type(see below) No. and Street Type - Description U Unrestricted Buildings up to 35,000 cu. ft.) R Restricted 1&2 Firmly Dwelling City/Town, State,ZIP IN iblasonr RC Roofing Covering WS Window and Siding SF Solid Fuel Burning Appliances I Insulation 'relz hone Email address D Demolition 5.2 Registered Home Improvement Contractor(HIC) H[C Registration Number Expiration Date IIIC Company Name or 111C Registrant Name No. and Street Email address City/Town, State, ZIP Telephone SECTION 6: WORKERS' COMPENSATION INSURANCE AFFIDAVIT (M.G.L c. 152. § 25C(6)) Workers Compensation Insurance affidavit must be completed and submitted with this application. Failure to provide this affidavit will result in the denial of the Issuance of the building permit. Signed Affidavit Attached? Yes .......... ❑ No ...........❑ SECTION 7a: OWNER AUTHORIZATION TO BE COMPLETED WHEN OWNER'S AGENT OR CONTRACTOR APPLIES FOR BUILDING PERMIT [, as Owner of the subject property,hereby authorize to act on my behalf, in all (natters relative to work authorized by this building permit application. Print Owner's Name(Electronic Signature) Date SECTION 7b: OWNER' OR AUTHORIZED AGENT DECLARATION J By entering my name below, I hereby attest under the pains and penalties of perjury that all of the information X contained in t 's Ia r1'is true and accurate to the best of my knowledge and understanding. z-Zi - Z013 Print vner's or Authorized:\ mt's ' ne(Electronic Signature) Date NOTES: I. An Owner who obtains a building permit to do his/her own work, or an owner who hires an unregistered contractor (not registered in the Home Improvement Contractor(HIC) Program), will not have access to the arbitration program or guaranty fund under M.G.L. c. 142A. Other important information on the HIC Program can be found at www.mass.gov.oca Information on the Construction Supervisor License can be found at www.r11asS.-0V C10 2. When substantial work is planned, provide the information below: Total floor area(sq. ft.) _(including garage, finished basement/attics, decks or porch) Gross living area (Sq. ff.) _ Habitable room count Number of fireplaces- ;`lumber of bedrooms Number of bathrooms Number of half/baths _ Type of hearing System Number of decks/ porches I'ti'pe of eooling system__.--_----.--- Enclosed 3. -Total Project Syu:ue PnoCme" m ty be sub�titutcd rot ''total Project Cost" --__ - The Commonwealth of Massachusetts W Board of Building Regulations and Standards CITY OF Massachusetts State Building Code, 780 CNIR SALEM Revised Mar 2011 Building Permit Application To Construct, Repair, Renovate Or Demolish a One-or Two-Family Dtivelling This Section For'Officiat Use Only. Building Permit Number: Date Applie Building Official(Print Name ''S�gnat Date SECTION 1: SITE INFORMATION 1.1 Property Addres: 1.2 Assessors Map& Parcel Numbers 5 2— Cci90 S I ( ' l.la [s this an accepted street?yes no Map Number Parcel Number 1.3 Zoning Information: 1.4 Property Dimensions: Zoning District Proposed Use Lot Area(sq It) Frontage(ft) 1.5 Building Setbacks (it) Front Yard Side Yards Rear Yard Required Provided Required Provided Required Provided 1.6 Water Supply: (M.G.L c. 40,§ 54) 1.7 Flood Zone Information: 1.8 Sewage Disposal System: Zone: _ Outside Flood Zone? Public ❑ Private❑ Municipal if yes❑ unicipal❑ On site disposal system ❑ SECTION2:, PROPERTY'OWNERSIIIP!' 2. ,,0 i+�r';.ofRecord `Di uf�'1 � � �j2jcescruez SDI , Ole, X Name(Print) City,State,ZIP Z cctbo1 5T AP ll+�3' 6o1 - 6w� No. and Street Telephone Email Address SECTION 3: DESCRIPTION OF PROPOSED WORK=(check all that apply) New Construction ❑ Existing Building❑ Owner-Occupied ❑ Repairs(s) ❑ Alteration(s) ❑ Addition ❑ Demolition ❑ Accessory Bldg. ❑ Number of Units_ Other ❑ Specify: Brief Description of Proposed Work': SECTION 4: ESTIMATED CONSTRUCTION COSTS Estimated Costs: Item Official Use Only%. Labor and Materials 1. Building $ I Building Permit Fee S Indtcaie how fee is determined: �. Electrical $ ❑ Standard City/Town Application Fee ❑Total Project Cost'—(Item 6)x multiplier x 3. Plumbing S 2. Other Fees: $ t Mechanical (FIVAC) S List 3. Mechanical (Fire S Sn� ression) Total All Fees: .S r— Check No. Check:\motmt: Cash Amount 6 Total Project Cost: $ 4j4Qt ❑ Paid in Fall 0 Outstanding Balance Duo: r SECTION 5: CONSTRUCTION SERVICES 5.1 Consttvction Supervisor License(CSL) License Number Expiration Date Name ofCSL Holder List CSL Type(see below) No. and Street Type - Description U Unrestricted Buildings up to 35,000 cu. ft.) R Restricted 1&2 Firmly Dwelling City/Town, State,ZIP IN iblasonr RC Roofing Covering WS Window and Siding SF Solid Fuel Burning Appliances I Insulation 'relz hone Email address D Demolition 5.2 Registered Home Improvement Contractor(HIC) H[C Registration Number Expiration Date IIIC Company Name or 111C Registrant Name No. and Street Email address City/Town, State, ZIP Telephone SECTION 6: WORKERS' COMPENSATION INSURANCE AFFIDAVIT (M.G.L c. 152. § 25C(6)) Workers Compensation Insurance affidavit must be completed and submitted with this application. Failure to provide this affidavit will result in the denial of the Issuance of the building permit. Signed Affidavit Attached? Yes .......... ❑ No ...........❑ SECTION 7a: OWNER AUTHORIZATION TO BE COMPLETED WHEN OWNER'S AGENT OR CONTRACTOR APPLIES FOR BUILDING PERMIT [, as Owner of the subject property,hereby authorize to act on my behalf, in all (natters relative to work authorized by this building permit application. Print Owner's Name(Electronic Signature) Date SECTION 7b: OWNER' OR AUTHORIZED AGENT DECLARATION J By entering my name below, I hereby attest under the pains and penalties of perjury that all of the information X contained in t 's Ia r1'is true and accurate to the best of my knowledge and understanding. z-Zi - Z013 Print vner's or Authorized:\ mt's ' ne(Electronic Signature) Date NOTES: I. An Owner who obtains a building permit to do his/her own work, or an owner who hires an unregistered contractor (not registered in the Home Improvement Contractor(HIC) Program), will not have access to the arbitration program or guaranty fund under M.G.L. c. 142A. Other important information on the HIC Program can be found at www.mass.gov.oca Information on the Construction Supervisor License can be found at www.r11asS.-0V C10 2. When substantial work is planned, provide the information below: Total floor area(sq. ft.) _(including garage, finished basement/attics, decks or porch) Gross living area (Sq. ff.) _ Habitable room count Number of fireplaces- ;`lumber of bedrooms Number of bathrooms Number of half/baths _ Type of hearing System Number of decks/ porches I'ti'pe of eooling system__.--_----.--- Enclosed 3. -Total Project Syu:ue PnoCme" m ty be sub�titutcd rot ''total Project Cost" --__ - s vim PUBLIC PROPERTY DEPARTMENT KINUKM-EY DRISGOLL MAYOR 120 WAW NGTON STREET Swi`u .�.1.SSACHI:$El'iS 01970 T EL 978-745-9595 0 FAx 97&7.10-9U6 APPLICATION FOR THE REPAIR, RENOVATION CONSTRUCTION DEMOLITION. OR CHANGE OF USE OR OCCUPANCY FOR ANY EXISTING STRUCTURE OR BUILDING 1.0 SITE INFORMATION Location Name: 37- CA►30T Building: J2� Property Address: Property is located in a; Conservation Area Y/N_�Historic District Y/N N 2.0 OWNERSHIP INFORMATION 2.1 Owner of Land S Name: Address: 3 2 C-A v3o7 sT• Telephone: 3.0 COMPLETE THIS SECTION FOR WORK IN EXISIIN a BUILDINGS ONLY Addition Existing Renovation Number of Stories Renovated Change in Use New Demolition Existing Approximate year of Area per floor (so Renovated construction or renovation of existing building New Brief Description of Proposed Work: /a , 13 ICP�(1�� P, lei`��o,�s - �f%fiifi �ov� 4hai- kodS h Fo rc4 — FIoor cat peg 11 . Mail Permit to: o.qe 6w �� What is the current use of the Building? e7l, , A� Material of Building? t v � If dwelling. how many units? N Will the Building Conform to Law? ��'eS Asbestos? r-- Architect's Name Address and Phone j Mechanic's Name Address and Phone Construction Supervisors L c�se# HIC Registration# Estimated Cost of Project$�Op'0d Permit Fee Calculation Permit Fee$Q?eTO/� Estimated Cost X$7/$1000 Residential Estimated Cost X$11/$1000 Commercial An Additional $5.00 is added as an Administrative charge. I 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 th ovstated specifications. Signed under penalty of pe ury Date © 2-G o 6 N Cfl --w --4--