3A SPRUANCE WAY - BUILDING INSPECTION -7119
PUBLIC PROPERTY
DEPARTMENT
MAYM 130 WAWINGww b`[1Fzr
"LLK S(nssAalt;st1"ts 01970
T%z_T USAS9S•FAx 97s.749tN
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: IG'ce�eiy,,f� Sao . Building.
Property Address:
Property Is located in a:Conservation Area Y/N Historic District Y/N
2.0 OWNERSHIP INFORMATION
2.1 Owner of Land _
Name:
Address:
Telephone: 177 efo
3.0 COMPLETE THIS SECTION FOR WORK IN MUSTWO 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:
The Chimney
P.O. Box 4074 - ---.
Mail Permit to: 978-977-9909)
What is the current use of the Building?
Material of Building? It dwelling, how many units?
Will the Building Conform to Law? Asbestos?
e rmney uys
Architect's Name
Address and Phone eeahody, MA 01960 ( )
Mechanic's Name 978-977-9900
Address and Phone
Construction Supervisors License M HIC Registration 0
Estimated Cost of Project$4e Permit Fee Calculation
Permit Fee i Estimated Cost X$7/$1000 Residential
Estimated Cost X$11/i1000 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 dd ttlo the above stated
specifications. Signed under penalty of perjury X
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