1D SPRUANCE WAY - BUILDING INSPECTION (3) ErrroF _ -
PUBLIC PROPERTY
DEPARTMENT
KI\MGN GY p\lily V 1
Nwroe 130 WA4UIi4TIxa S'IIEhT � ��Ot970
Txa 9'47ii959S PAM M740.96K
APPLICATION FOR THE REPAIR RENOVATION CONSTRUCTION
DEMOLITION. OR CHANGE OF USE OR OCCUPANCY FOR ANY ERISTINCl
STRUCTURE OR BUHMIIN
1.0 SITE INFORMATION
Location Name: �f,3 �,,� Building: / - p
-----
Property Is located in a:Consavatbn Arsa YIN Hlstorfc 01shict YIN
2.0 OWNERSHIP INFORMATION
2.1 Owner of Land
Name:
Address:
Telephone: 75- 9 Z cl9 00
3.0 COMPLETE THIS SECTION FOR WORK IN EXISIINO BUILDINGS ONLY
Addition Existing
Renovation l/ 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
P.O. Box 4074
- - -- _-Peabody,MA_01-960- — — — - -
-------Mail Permit to: -
What is the Current use of the Building?
Material of Building? if dwelling.how many units?
Wit the Building Conform to Law? Asbestos? -
The tmney uys
ArchitwXs Name
Address and Phone Penhad M e n 1960 (, )
Mechanb'a Name
978-977-9900
Address and Phone
Construction Supervisors License# HIC Registration#
Estimated Cost of Projed S Permit Fee Calcuintion
Permit Fee i Estimated Cost X$7/$1000 Residential
Estimated Cost X$411S1000 Commercial--
An Additional $5.00 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 build to the above stated
specifications. Signed under penalty of perjury
Date
r
2 p
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