2D NIMITZ WAY - BUILDING INSPECTION What is the current use of the Building?
Material of Building? If dwelling, how many units?
win the Building Conform to Law? Asbestos?
The Chimney Guys
Architect's Name
Address and Phone Pen h aft h 01960 —t j
Mechanic's Name 978-977-9900
Address and Phone
Construction Supervisors License 0 HIC Registration 0
Estimated Cost of Project S o� Permit Fee Calculation
rm
permit Fee i -- — Estimated Cost X$7IS1000 Residential
Estimated Cost X$111$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 b d to the above stated
specifications. Signed under penalty of perjury
Date
C�
0
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00
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---- CITY-OF-g r- -
PUBLIC PROPERTY
"a, DEPART)IENT
KI.mW.,EV DRL%CU. . 6
MAYM t 20 WwvaNCMW h-ntM•
&uAiK Hn►tAOHLsti-rs 01970
14L 975-745-95"•PAX 976.740.96"
APPLICATION FOR THE REPAIR. RENOVATION, CONSTRUCTION.
DEMOLITION. OR CHANGE OF USE OR OCCUPANCY. FOR ANY EXISTING
STRUCTURE OR BUILDING
loll SITE INFORMATION
Location Name: Building: a p
Property Address:
Property Is located in a:Conservation Area YIN Historic Oistrkd Y/N
2.0 OWNERSHIP INFORMATION
2.1 Owner of Land
Name: _
Address:
Telephone: 7 p Q
3.0 COMPLETE THIS SECTION FOR WORK IN FYIQTtNn BUILDINGS ONLY
Addition Existing
Renovation v 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:
�e�'G-tee
Mail Permit to: