5A NIMITZ WAY - BUILDING INSPECTION What is the current use of the Building?
Material of Building? It dwelling, how many units?
Will the Building Conform to Lie-caamaey ( nvc Asbestos?
Architect's Name P.O. Box 4074
Peabody, MA 01960 t
Address and Phone 1-9900
Mechani's Name
Address and Phone
Construction Supervisors License# HIC Registration#
Estimated Cost of Project$—ALCQS—D Permit Fee Calculation
Permit Fee$_�--- Estimated Cost X$71$1000 Residential
Estimated Cost X$11/$1000 Commerciat
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 'ld to the above stated
specifications. Signed under penalty of perjury X
Date ! 3 O
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14197a-7JS-95"• FAx.976.7i0.96K
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:
Property Is located in a; Conservation Area Y/N Historlo District YIN
2.0 OWNERSHIP INFORMATION
2.1 Owner of Land
Name:
Address.
_ �� ✓U I�M 1-f`� LJ�
Telephone: -) p U
3.0 COMPLETE THIS SECTION FOR WORK IN r=YtgrtNa BUILDINGS ONLY
Addition Existing
Renovation v Number of Stories Renovated
Change in Use Now
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: ---