1C SPRUANCE WAY - BUILDING INSPECTION PUBLIC PROPERTY
DEPARTNIENT
MAYOR 120 WAsHiNcrc*i-!iTR.r=r,*.,SALF 1MASSACHl;SLI-M 01970
CFE 97.8 7}5 9545 4,FA; 978.740-9546
APPLICATION FOR THE REPAIR, RENOV;ktbN, CONSTRUCTION,
DEMOLITION OR CHANGE OF USE OR OCCUPANCY, FOR ANY EXISTING
STRUCTURE OR BUILDING
9.0 SITE INFORMATION
Location Name: e'���,w,�,�,, Building: AL
Property Address:
Property is located in a: Conservation Area YIN 4/ Historic District YIN
2.0 OWNERSHIP INFORMATION
2.1 Owner of Land _
Name:
Address:
Telephone: 7 p'7C
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 (sO Renovated
construction or renovation
of existing building New
Rrieff Description of Proposed Work:
The Chimney Guy
P.O. Boa 4074
ea o y, 960 -
Mail Permit to:
What is the current use of the Building?
Material of Building? If dwelling, how many units?
Will the Building Conform to Lav Asbestos?
Architect's Name P.O. Boa 4074
Address and Phone Peabody,MA 01960
Mechanic's Name
Address and Phone
Construction Supervisors License# HIC Registration#
Estimated Cost of Project$ ,2COCT— Permit Fee Calculation
Permit Fee$ Estimated Cost X$7/$1000 Residential
Estimated Cost X$111$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 to the above stated
specifications. Signed under penalty of perjury /� v
Date 3Nc-��
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N
0
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41
F U 9
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