1B NIMITZ WAY - BUILDING INSPECTION EI�OF SALE. -- —
' PUBLIC PROPERTY
DEPARTMENT
KimBFJREY DRISCOLL
MAYOR �' pCfPt 11 Y
120 WASH11vOic/N b'TRFPI' ,4%ttiSACFIl;SkllS O1970
'I�l.:978-745�9595 F669*740.9W
APPLICATION FOR THE REPAIR, RENOVATION. CONSTRUCTION,
DEMOLITION, OR CHANGE OF USE OR OCCUPANCY, FOR ANY Y EXISTING
STRUCTURE OR BUILDING
1.0 SITE INFORMATION
Location Name: Building: 1- 3 r wfy
Property Address:
Properly is located in a;Conservation Area YIN eG Historic District Y/N
2.0 OWNERSHIP INFORMATION
2.1 owner of Land
Name: e P t) i'
Address:
Telephone: C / !
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:
The Chimney Guys
P.O. Boa 4074
- ----.--- - Peabody,MA 01--%0 -
- Mail Permit to: --
What is the current use of the Building?
Material of Building? If dwelling, how many units?
Will the Building Conform to Law? Asbestos?
The Chimney Guys
Architect's Name P.O. Box 4074
Address and Phone Pe-hody,MA 01960
Mechanic's Name 978-977-9900
Address and Phone
Construction Supervisors License# HIC Registration#
Estimated Cost of Project$ — 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 build to the above stated
specifications. Signed under penalty of perjury
Date
of
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