10B RUSSELL DR - BUILDING INSPECTION What is the current use of the Building?
Material of Building? It dwelling.how many units?
Will the Building Conform to Law? Asbestos?
The Chimney Guys
Architect's Name ex
Address and Phone t
Mechanic's Name 978- -
Address and Phone
Construction tion Supervisors License# HIC Registration#
Estimated Cost of Project S f`5� Permit Fee Calculation
Permit Fee S Estimated Cost X$7/$1000 Residential
Estimated Cost X$11/111000 Commercial
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An Additional $5.00 is added as an
Administrative charge.
legibly written to avoid delays in processing.
Make sure that all fields are properly and
The undersigned does hereby apply for a Building Permit to build to the above stated
specifications. Signed under penalty of perjury
Date
x
a
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C=OF- N1 -
PUBLIC PROPERTY
DEPARTMEINT 112�, p
MAvon 130WAPamc Tnu bntusr an►hK%Inss%olLst-ns 01970
TaL.97L745-9M•FAx:97e.740.9"6
APPLICATION FOR THE REPAIR. RENOYMON. CONSTRUCTION,
DEMOLITION, OR CHANGE OF USE OR OCCUPANCY, FOR ANY EXISTING
STRUCTURE OR BUILDING-
1.0 SITE INFORMATION
Location Name: Building: O
_ Property Address:-- ----- -- - -- -- -- - - ----- - --_ -- - -- _.
Properly Is bested in a;Corumvatlon Area Y/N s'' Hiftric District YM
2.0 OWNERSHIP INFORMATION
2.1 Owner of Land
Name: e 1?
Address:
Telephone: y .7 ' c3 C,-O
3.0 COMPLETE THIS SECTION FOR WORK IN18TrNn BUILDINGS ONLY
Addition Existing
Renovation Number of Stories Renovated
Change in Use a- New
Demolition Existing
i Approximate year of Area per floor (sf) Renovated
construction or renovation
of existing building New
Brief Description of Proposed Work:
The Chimney Guys
- - - - --Peabody;Mt 01960-- - - --- --
Mail Peanit to: 978-977-9900
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