2B HALSEY WAY - BUILDING INSPECTION What is the Current use of the Building?
Material of Building? If dwelling. how many unfts7
will the Building Conform to Law? Asbestos?
Architect's Name
Address and Phone
Mechanic's Name
Address and Phone
Construction Supervisors License HIC Registration#
Estimated Cost of Project Ste= m Permit Fee Calculation
Permit Fee i Estimated Cost X$7/111000 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 rocessing.
The undersigned does hereby apply for a Building Permit to bull a above stated
specifications. Signed under penalty of pedury
Date/ 3 0`7
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- CITY-OFSALETNI
PUBLIC PROPERTY
DEPARTNII&NT
,:I.MEXLEY DRLUXAL
MAvoe 120 WALUNGTnN MEET•!N.Yn MA\tAOHl:5hll3 01970
TM-978-745.95"* FAx 979.740.98"
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: �o r�� Building:
Property Address.
Properly Is located in a; Conservation Are&YY N ^J /Historic Oftict YM
2.0 OWNERSHIP INFORMATION
2.1 Owner of Land _
Name: 1121- , C`Z
Address: 6
Telephone:
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
9def Description of Proposed Work:
— - - Mail Perrnit to: