11A RUSSELL DR - BUILDING INSPECTION Uri F �u
' PUBLIC PROPERTY
DEPARTMENT
Kl.%BFJU-FY DRISCOLL
SIAYOR IA WAWINGT N/STREET 1 Ste;MtsSAc]fUSEI-Is 01970
1'M 97&745-95951 F:�x:97&740.9846
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 ^ Historic District YIN_e
2.0 OWNERSHIP INFORMATION
2.1 Owner of Land _
Name:
Address: �SLq/
Telephone: e— p0— 3 S
3.0 COMPLETE THIS SECTION FOR WORK IN EXL TLUG BUILDINGS ONLY
Addition Existing
Renovation Number of Stories Renovated
Change in Use New
Demolition Existing
Approximate year of Area per floor (so Renovated
construction or renovation
of existing building New
Brief Description of Proposed Work: )
GvSe/� Gh� hne� �/�n�i sys�e n C��l.✓C y/
6=-' c "ove d
The Chimney,Guys
---
Mail Permit to: 978-9'77-9900
What is the current use of the Building? C C, e
Material of Building? If dwelling, how many units?
Will the Building Conform to Law? Asbestos?
Architect's Name The Chimney Guys
ox 4074
Address and Phone P.O. B
Peabody,
Mechanic's Name 978 977 9200
Address and Phone
Construction Supervisors License# HIC Registration#
Estimated Cost of Project S S-00, b Permit Fee Calculation
Permit Fee$ Estimated Cost X$741000 Residential
— — —— --- -- -- ----- -- Estimated-Cost-X$14/$1000Commercial
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 stated
specifications. Signed under penalty of perjury /� -
Date
` of
of N
V ra, 9
� a
a � 4
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