2A NIMITZ WAY - BUILDING INSPECTION (002) What is the current use of the Building?
Material of Building? ifdwelling,how many units?
Win the Building Conform to Law?
Asbestos?
Architect's Name The Chimney
P.O. Box 4074
Address and Phone ft%W0TY-1
Mechanic's Name
Address and Phone
Construction Supervisors Ucense HIC Registration#
Estimated Cost of Project i ��— permit Fee Calculation
Permit Fee$ Estimated Cost X$7I111000 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
to
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a o.
EI'rroF-SALETN _- --
PUBLIC PROPERTY
119) DEPARTMENT 4
KI\MFJLfiY D�ww
SWOR 120 WA%uNGmw S tEn SAua4 mASSAa1L5ETIS 01970
14a-M74&95"♦FAs 978-740.""
APPLICATION FOR THE REPAIR. RENOVATION, CONSTRUCTION
DEyiOLITIOM OR CHANGE OF USE OR OCCUPANCY, FOR ANY EXISTING
STRUCTURE OR BUILDING
1.0 SITE INFORMATION
Location Name: Building:
- --
Property Address.--------- -- — -- ---- -- - - ---- - ----- _ _
o?tQ (aJ
Properly Is klcated in a:Conservation Area Y Historic District YIN
2.0 OWNERSHIP INFORMATION
2.1 Owner of Land
Name: �p
Address:
Telephone: O
3.0 COMPLETE THIS SECTION FOR WORK IN E7(IS ING BUILDINGS ONLY
Addition Existing
Renovation Number of Stories Renovated
Change in Use C New
Demolition Existing
Approximate year of Area per floor (sf) Renovated
construction or renovation
of existing building New
Brief Description of PropoAsedd Work:
The Chimney Guys
- Peahndy,MA 01966
Mail Permit to: 978-977-9900