4B HART WAY - BUILDING INSPECTION • w
What is the current use of theBuilding?
Material of Building? �`-)oo It dwelling.how many units?--L�
Win the Building Conform to Law? NIA
ye-5 Asbestos?
Archited's Name
/A
Address and Phone N ( )
Meahanio's Nams
Address and Phone N °
HIC Registration#
Construction Supervisors License 0 O 1Supervisors `
Estimated Coat of Projed$ S• g60_ °` Pemnit Fee Calwlafbm
Permit Fee S '°o Estimated Cost X$71$1 000 Residential
Estimated Cod X$/141000 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 /- c
Date
.+ y
1 � �
d
' a
PUBLIC PROPERTY
DEPARnIENT
IGINCHND�UI�. a �,.-r
NAraa
130 WASMN rM!�'T•SALE4 NAMACKSLI'M 01970
W O TEL-978-745-9595 1 FAX 976740.966
APPLICATION FOR THE REPAIR RENOVATrON CONSTRUCTION
DEMOLITION. OR CHANGE OF USE OR OCCUPANCY FOR ANY EXISTING
OR BUILDING
DING
1.0 SITE INFORMATION "
Location Name. Building:
Prop— --
erty Address:— — 54
Property is located in a:Conservation Arse Y/N N_Hlat &Dftkti Y/N /-,j
2.0 OWNERSHIP INFORMATION
2.1 Owner of Land (�.
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 (SO Renovated
construction or renovation
of existing building New
Brief Description of Proposed Work: I
------- Mail Permit to: as L-ti ei ! l lam,