5B NIMITZ WAY - BUILDING INSPECTION What is the current use of the Building?
Material of Building? it dwelling,how many units?
ill the Building Conform to Law? Asbestos?
W The Chrmaey uys
Architect's Name
Address and Phone PpAhod} MA 01960 ( )
Mechanic's Name 978-977-9900
Address and Phone
Construction Supervisors License# HIC Registration#
Estimated Cost of Project$ t;I OO o Permit Fee Calculation
Permit Fee t-2;- Estimated Cost X$7/$1000 Residential
Estlmated Cost X$i ll$1000 Commercial
An Additional 55.00 is added as an
Administrable charge.
Make sure that all fields are properly and legibly written to avoid delays in processing.
The undersigned does hereby apply for a Building Permit to b Itl to the above stated
specifications. Signed under penalty of perjury X /✓��/
Date / 3 O
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CITY-OF-SALE$ --
PUBLIC PROPERTY
I's DEPARTMEINT 2-6gmewim�ORMC Il ah
%1AYOe 130 WwaNGr(W SW"#S.urx MAStAO1l:5h'll3 01970
TM 979-74S-9S9S•Fex:97e-740.9W
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: Ki��h� ,. Building:
Property Address: J O
Property Is located in a:Conservation Area Y/N Historic bTstrict Y/N
2.0 OWNERSHIP INFORMATION
2.1 Owner of Land _
Name:
Address:
Telephone: -7<9 rj-n i3 Q O
3.0 COMPLETE THIS SECTION FOR WORK IN EX STtNn BUILDINGS ONLY
Addition Existing
Renovation L/ 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: