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10 HERSEY ST - BUILDING INSPECTION -Cmrop- V. -- PUBLIC PROPERTY DEPARTMENT KUMFJU"ORMCOLL MAYOR 120 WmmNGTON SMEEr•"Luk WAAAcHt shTrs 01970 'Ik7.:978-745-9595 0 FAIL:978-740.9846 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: Building: Property Address: !O 4e rsQ,-L Sf Property is located in a; Conservation Area YIN Historic District Y/N 2.0 OWNERSHIP INFORMATION 2.1 Owner of Land _ Name: v1 Address: ��r 37 W� Telephone: / 9 7 3.0 COMPLETE THIS SECTION FOR WORK IN EXISTING BUILDINGS ONLY Addition Existing Renovation Number of stories Renovated 3 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: MaW tits k4j s aM b6tg "Wr Mail Permit to: kyblu�rit '.rro ©1 c7 °(Ccdki �b � �,c."Vr What is the current use of the Building? > -Fn" \ Material of Building? u gzd-lit( r C(f If dwelling. how many units? Will the Building Conform to Law? Asbestos? Architect's Name Address and Phone ( ) Mechanic's Name J' Address and Phone /U-7 WjoOt/Ov g+ r�1 c Construction Supervisors License# 9nrr0 HIC Registration# Estimated Cost of P o'e 0 Permit Fee Calculation Permit Fee$ Estimated Cost X$7/$1000 Residential Estimated Cost X$11/$1000 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 b4V to the above stated specifications. Signed under penalty of perjury X Date N r1 nl CL G6---- CriY OF SALEm PUBLIC PROPERLY DEPA>i M014T CUMLamoNOXILL ,nL 97►7454M&PAS f7674Nw Coas&ucdoa Debr r Dkpossl AHWsvit (eaquiead 6 A AMON=god mw4adam woad* la seodaeos wit ,5i HmHft Codst 7S0 C1dz sod=1113 BduUdbe t+ook is issoad wit cos 000ddas lost dw darts eaaaWy dvs ghk wok"bs&Voaad Otis a yeW* bm"wwo&god ddft as 4oft"by MM O The darw v(U be tiaaspotad by: C (am a[bsato T!w dobds will be disposM o[in: ("Met heitiM (mldeus d heil(ryf �1W Wt alA+rmit�pPliad . 1 1 07 d>�