4 HODGES CT - BPA-2007-720 INTERIOR PLASTERING E
PLI`I'�OF�XCEC -.
BLIC PROPERTY
DEPr1R'ItitEI�tT
I:I�MEt1FY DRLtiI:ULL
MAYOR 120 WASMNG ON SME6r 0 Ste,MAZACHLSin-M 01970
TIEL 978-745-9S9S 6 FNC 978-740.9846
APPLICATION FOR THE REPA_M RENOVATION, CONSTRUCTION.
DEMOLITION OR CHANGE OF USE OR OCCUPANCY, FOR ANY EXISTING
STRUCTURE OR BUILDING
F1.0TE INFORMATION
ion Name: Building:
rly Address:
•Pivv�
property is located in a-,Conservation Area Y/N— d�__Historic District YIN
2.0 OWNERSHIP INFORMATION
2.1 Owner of Land _
Name:
Address: /ltr ,f,
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:
o--- � 5�7�1�'�-mil � - //Uf✓/a�C � Gf'e - �.�c,/
Mail Permit to:
What is the current use of the Building?
Material of Building? �v� If dwelling. how many units? o
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 Proj $ I a, 0 U O 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
tttoo/build to the above stated
specifications. Signed under penalty of perjury X d/ '
Date a
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