327 JEFFERSON AVE - BPA B-2007-239 En`r-OF-S ---
�'� PUBLIC PROPERTY
DEPARTMENT
KIMBERLEY DRISCOLL
MAYOR 120 WASHINGTON STREET•SALEM,MASSAC HLSLTI5 01970
TEL-978-745-9595 • FAm 978-74o-9s46
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:
q3Ll
Prop"is located in a-, onservation Area Y/N_ 'V Historic District Y/N _
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 (sf) Renovated
construction or renovation
of existing building New
Brief Description of Proposed Work:
Mail Permit to: t 0 Ky1�
What is the current use of the Building? � r
i
Material of Building? If dwelling, how many units?
Will the Building Conform to Law? Asbestos?
Architect's Name
Address and Phone
Mechanic's Name— ( � r �`
Address and Phone Q
Construction Supervisors License#G '�l,T HIC Registration#
Estimated Cost o P j $ <dr6— _ 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
Administrative charge.
Make sure that all fields are properly and legibly written to avoid delays in processing.
The undersigned does hereby apply for Building Permit to build to the above stated
specifications. Signed under penalty of perjury X
Date `rae i�
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N
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