10C RUSSELL DR - BUILDING INSPECTION Crry-oFSAAL.MiVIL - -
PUBLIC PROPERTY
DEPARTMENT
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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: -G.� P/L. Building:
- -
Property Is located in a:Conservation Arne YM Historic District YM
2.0 OWNERSHIP INFORMATION
2.1 Owner of Land
Name:
Address:
Q-1L-
Telephone: `j q 00
3.0 COMPLETE THIS SECTION FOR WORK IN MILKING BUILDINGS ONLY
Addition Existing
Renovation ✓ Number of Stories Renovated
Change in Use Now
Demolition Existing
Approximate year of Area per floor (sf) Renovated
construction or renovation
of existing building New
Brief Description of Proposed Work:
The Chimney Guys
Peabody-MA-01960- - -- -
Mail Permit to: 978-977-9900
What is the current use of the Building?
ifMaterial of Building? dwelling,how many units?
Win the Building Conform to Law y-e — Asbestos?
Architect's Name R 0 gay
�,01960
Address and Photo ' ^' Peabody, lYI
978-977-9900
Mechanids Name
Address and Phone
Construction Supervisors license 0 HIC Registration is
Estimated Cost of Projed Pemmt Fee Cakwlation
Permit Fee$ Estimated Cost X$7/$1000 Residential
Estimated Cost X S41/51000 Commercial--------An Additional$6.00 is added as an
Administrative charge-
Make sure that all fields are property and legibly written to avoid delays in processing.
The undersigned does hereby apply for a Building Permit to bu Id to the above stated
specifications. Signed under penalty of perjury
Date
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