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26 HANCOCK ST - BUILDING INSPECTION -CXMOFSALEM -- (� (� PUBLIC PROPERTY DEPARTMENT Kikffim 6Y DRISCULL MAYOR 12D WASHING ON SmEET♦SAI^u MAAACHLSLIYS 01970 TEL,978-74S-9S9S 1 FAx 978-740.9&16 APPLICATION FOR THE REPAIR, RENOVATION, CONSTRUCTION. DEMOLITION. OR CHANGE OF USE OR OCCUPANCY, FOR ANY EXISTING STRUCTURE OR BUILDING 1.0 SITE INFORMATION Location Na . G Building: Property Address: �iyyc'dC/r $'T Property is located in a; Conser0ation Area Y/N Historic District Y/N 2.0 OWNERSHIP INFORMATION 2.4 Owner of Land ' •�/ ' c4 e y OC Name: Address: 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 I New Brief Description of Proposed Work: 8u`LOrn O c'Tici6S -e- i Mail Permit to: 3 .- -- f c� What is the current use of the Building? Material of Building? a!% Y'Z If dwelling, how many units? Will the Building Conform to Law?_z1Br- Asbestos? Architect's Name Address and Phone Mechanic's Name la G'o _ " Sd a/Ss �/12.5� t/ Cy0 C'ff/LSTt9 Address and Phone i Construction Supervisors License# HIC Registration# Estimated Costt of Project $ OGQ'S Permit Fee Calculation Permit Fee ( Estimated Cost X$71$1000 Residential Estimated Cost X$11/$1000 Commercial An Additional$5.00 is added as an Administrable 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 � o N 0 a o ` © aViC `