3B SPRUANCE WAY - BUILDING INSPECTION EITY"OF
PUBLIC PROPERTY
DEPAR'I'11dENT
w..osa1<Y�w.,.ti
13097A9GWGW w snsar i sNALK-VAMACMUTM 01970
1111:M7454M 0 PAZ M740-900
AP CATION FOR TIIB REPAIR. RENOVAMON_ CONSTRUCTION
DEb[OLITION.OR CHANGE OF USE OR OCCUPANCY, FOR ANY EXISTING
STRUCTURE OR BUILDING
ce SITI3 INFORMATION
Location Name: cr n 6—'- - 19tmng:
Property ls locstad Ina:ConswvWon Arss YM Hkdorlo obbla YIN A
2.0 OWNERSHIP INFORMATION
9.1 Owner of Land
Name:
Address'
Telephone: O C S
3.0 COMPLETE THIS SECTION FOR WORK IN maindQ BUILDINGS ONLY
Addition Existing
Renovation Number of Stories Renovated
Change in Use -:2 New
Demolition Existing
Approximats year of Area per floor (0) Renovated
construction or renovation
of existing building Now
Brief Description of Proposed Work:
/c.e/'�o� f �C'Ct Cam �f�r~/✓��Ge. S: S �Cin
The Chimney Guys
Peabody,-MA Old
--- -- ---Mail Permit to: /'/-VVOO - - -
What a"Current us@ at the Building?
Material of BuildkV? if dwelling,how many units?
vvut the av�Conilonm to HW Asbestos?
Archit d*Name
Addnw"Pho Peabody, MA 01960 ( )
Liedwdes Nam
Address and Photo
�on Supervisors License if HIC Registration g
C«
Estimated Co of Project a / � PemYt Fes Cakulstlon
Cod
Permit Fee i Estimated Cost X$7/51000 Residmid0l
Estlrnated Cost X$41/:1000 Cmnmerdst-
An Additional$5.00 is added as an
Adminktradve etwgs.
slake sure that all nelds am properly and legibly written to avoid delays in processing.
The undarslg .ad doss hereby apply for a Building Permit to bulk! above
c ;
speefOcatlacm Signed under penalty of perjury
Date
i
�I
y
T T I