96 SWAMPSCOTT RD - BUILDING INSPECTION (26) What is the current use of the BuildingT
vn rn s 2 n- S/ C�Ga—ems
Material of Building? 51eS j If dwelling, how many units?
Will the Building Conform to Law? Asbestos?
Archited's Name
Address and Phone
Machanies Name n
Address and Phone 1 �n vt21
Construction Supervisors License# C 5`3 8S�/ HIC Registration#
Estimated Cost of Project$ S� O o 6 Permit Fee Calculation
Permit Fee$ 6 `� Estimated Cost X$7/$1000 Residential
Estimated Cost X$11/$1000 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 bull e e stated
specifications. Signed under penalty of perjury
Date6.
of
D V
\Q
s
E11YOF-gALE-N
PUBLIC PROPERTY
DEPART IMEI IT
wueEju.ratr natu:wt �J
MAYM 130 WASMN/Cnw VREET 0 '�ALlJ4 XA4SAQ/l5lTiS 01970
TEL 976-745-9"S*FAX 978-740.96"
APPLICATION FOR THE REPAIR. RENOVATION, CONSTRUCTION
DEMOLITION. OR CHANGE OF USE OR OCCUPANCY FOR ANY EXISTIN
STRUCTURE OR BUILDING
IA SITE INFORMATION
Location Name: Building: �j-7-
Property Address.
Property Is located in a:Conservation Area Y/N Historic Distrk t Y/N
2.0 OWNERSHIP INFORMATION
2.1 Owner of Land
Name: 05i.zi ^ o
Address: p
Telephone:
3.0 COMPLETE THIS SECTION FOR WORK IN t=lrtaTlurs 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
&ief Description of Proposed Work:
�057—
_--- - Mail Permit to: --_— -_
ti
✓ate 10� „ ✓`it""A", d
Board of Bwlding egu aho s an ten<art s
Construction Supervisor License
License: CS 53841
Expkation:;:41/2112009 Tr# 11415
t. Restf[ction: 00;
ROBERT C PIZA
40 CHESTNUT ST
_J