56A PICKMAN RD - BUILDING INSPECTION PUBLIC PROPERTY
DEP?l,RTMEINT
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SCAYOa 130 Wwa iw b-MM•"=;.MASsCHLui7S 01970
Ta-976.7+S-959S•FAx 978.740.96"
APPLICATION FOR THE REPAIR. RENOVATION, CONSTRUCTION.
DEMOLITION. OR CHANGE OF USE OR OCCUPANCY, FOR ANY EXISTING
STRUCTURE OR BUILDING
1.0 SITE INFORMATION
Location Nams: �, �cs�/G Building:
Property Address: JrG:yq /; r.1
Property Is located in a;Conservation Area Y/N A—� Historic Disbid YM
2.0 OWNERSHIP INFORMATION
2.1 Owner of Land
Name: 12, A/
Address: A
Telephone: 19 7,,a•-
3.0 COMPLETE THIS SECTION FOR WORK IN ElU LTWG BUILDINGS ONLY
Addition Existing
Renovation Number of Stories Renovated
Change in Use / New
Demolition Existing
Approximate year of Area per floor (sf) Renovated
construction or renovation
of existing building I
New
Brief Description of Proposed Work:
The Chimney Guys
Peabody, MA 01.960
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Mail Permit
What is the current use of the Building?
Material of Building? It dwelling,how many units?
Win the Building Conform to La Asbestos?
�'�e rmuey .
Architect's Name
Address and Phone Peabody MA 01960 ( )
Mechanic's Name 978-977-9900
Address and Phone
Construction Supervisors License# HIC Registration#
Estimated Cost of Projed S 97 Permit Fee Calculation
Permit Fee S Estimated Cost X$7/111000 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 t e above stat
specifications. Signed under penalty of perjury X
Date
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