5 HODGES CT - BPA-2007-175 ROOF -
`,; PUBLIC PROPERTY
������ DEPARTMENT
KIMBMEY DRISC(3LL
MAYOR 1-V WASHINCTON STREET♦$
Mau MA,SAC31l:SE1T501970
TFi 978-745-9595 0 FAII197&740-98.16
APPLICATION FOR THE REPAIR, RENOVATION CONSTRUCTION
DEMOLITION, OR CHANGE OF USE OR OCCUPANCY FOR ANY EING
STRUCTURE OR BUILDING
1.0 SITE INFORMATION
Location Name: Building:
Property Address: /�o� pS �T
Property is located in a; Conservation Area Y/N Historic District Y/N
2.0 OWNERSHIP INFORMATION
2.1 Owner of Land
Name: LG
Address:
Telephone:
3.0 COMPLETE THIS SECTION FOR WORK IN EXL TLbLG 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
Eief Description of Proposed Work:
l� tib Ire /,4V2 lW P 1E� g 1 `Ter
- -
Mail Permit to:
What is the current use of the Building?
Material of Building? 1e .,n 061 If dwelling, how many units?
Will the Building Conform to Law? Xa6 —
Asbestos?
Architect's Name
Address and Phone
Mechanic's Name /
Address and Phone
Construction Supervisors Licens�e/#
HIC Registration# `� 7S
Estimated Co t of Project$ 6 00' cC) 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 BuildingPermit Puild to the a stated
specifications. Signed under penalty of perjury X
Date Sr
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