GROVE ST - BUILDING INSPECTION ' PUBLIC PROPERTY
DEPART NIEINT
Vass ALEY OuSCULL
%"Yot 120 WASNJNCTONSTREET•5'�X%hSAC LSkn-301970
TM,978-745-959S 6 FAS 978•740.9816
APPLICATION FOR THE REPAIR. RENOVATION. CONSTRUCTION.
DEMOLITION OR CHANGE OF USE OR OCCUPANCY, FOR ANY VaSTING
STRUCTURE OR BUILDING
1.0 SITE INFORMATION
Location Name: o/v—r G E F�ET�q/�—r8uilding:
Property Address:
property is Located in a;Conservation Area Y/N Q_Historic District Y/N J O
2.0 OWNERSHIP INFORMATION
2.1 Owner of Land _
Name:
Address: 6,?vdA S7
Telephone: 9'74— -7 yy 6 / T./w ZhVlDA� T
3.0 COMPLETE THIS SECTION FOR WORK IN EXISTING BUILDINGS ONLY
Addition Existing
Renovation Number of Stories Renovated
Change in Use New
Demolition Existing 2 pp0 5,f
Approximate year of Area per floor (sf) Renovated
construction or renovation New
of existing building
arief Description of Proposed Work:
I-ZgFl I 5/Aiklo Aw//Ub0c✓S
r`. W WINWo1//5
--- - ------Mail Permit to: --- � ✓f- Er/ ��_ 0�970 - --- -
What is the current use of the Building? IA&>k19Af El.Jd 84Y-rrXT
Material of Building? b"OJ If dwelling, tow many units?
Will the Building Conform to Law? 757 Asbestos? // d
Architect's Name
Address and Phone
Mechanic's Namei9sffEL j!:�pr�77Tf�Ti2� itiL
Address and Phone If 5k-ZZAtiz ff✓6 5��/'r ��•
Construction supervisors License# 066 7 3 y HIC Registration#
Estimated Cost of Prol , $ 542 0 Permit Fee Calculation
Permit Fee$_'_tg 2�• Estimated Cost X$7/51000 Residential
Estimated Cost X$11/$1000 Commercial
An Additional $5.00 is added as an
Administrative charge.
Make sure that all fields are property and legibly written to avoid delays in processing.
The undersigned does hereby apply for a Building
�Permit
jtoo build to the above stated
specifications. Signed under penalty of perjury
Date 3 Z-O o'
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