8D RUSSELL DR - BUILDING INSPECTION What is the current use of the Building?
Material of Building? If dwelling. how many units?
Chimney Guys Asbestos?
WiU the Building Conform to Box 410174
Architect's Name
Address and Phone 978-977-9900 ( )
Mechanic's Name
Address and Phone
Construction Supervisors license# HIC Registration#
Estimated Cost of Project$ 00,02 Permit Fee Calculation
Permit Fee t Estimated Cost X$7i$l000 Residential
Estimated Cost X$i l/St000 Commerclal
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 buf to the above stated
specifications. Signed under penalty of perjury X
Date
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1 y AN
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PUBLIC PROPERTY
"Is DEPARTMENT
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MAYM I20wASNINGIi7N SRFEr•
SALEK NrASSAOiLStIIS 01970
TE1:97674S-9S9S•FNc:976.740-9a4i
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: p
Property Address. h y y
Property Is located in a; Conservation Area Y/N Historic Dbtrlot YIN
2.0 OWNERSHIP INFORMATION
2.1 Owner of Land
Name:
Address: c
Telephone: p'
3.0 COMPLETE THIS SECTION FOR WORK IN EXISTING 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 New
Brief Description of Proposed Work:
Mail Permit to: