11 TANGLEWOOD LN - BUILDING INSPECTION CITY OF SALEINI
PUBTAC PROPERTY
DEPARTNIEN'].-
Nf I W
APPLICATION FOR PLAN EXAMINATION AND BUILDING PERMIT
ALL STRUCTURES EXCEPT I AND 2 FAMILY DWELLINGS
IM-ORTAN'T:Applicants must complete all itent.,on this page
SITE INFORM
Location Name ffl-GTLAND C0ND0MINIUUi,,i,,
Property Address 11 TAN-GLEWOOD LANE
Map
Located in: Conservation Area Y Z Historic district
Use Groups
(check one)
Residential(3 or more Units) R2 X,
Type of improvement Residential (hotel/motel RI
(check one) Assembly(churches) A]
New Building— Assembly(nightclubs etc) A2
Addition Assembly(restaurants,recreation) A3
Alteration Business R
Rcpair/ReTio-c;,711ent t� Educational E
Demolition ✓— Factory(moderate hazard) F
,Uove!Rclocatc — Factory(low hazard) F2
foundation Only — High HazArd If
Accessory Building__ Institutional (residential care) IT—
Other(describe) Institutional (incapacitated) 12
Institutional (restrained) 13
Mercantile !V11
Storage(moderate Int-rard) sl
Storage(ImN hazard) S2—
OWNERS1111?INFORMATION(Please t,pc or Print Clearly)
OWNER Name 7 14 1
Address Z�6
.Z (117zg 7- 2!12
Telephone
DESCRIPTION OF WORK TO BE PERFORIVIVA)
Remodel After water damage from defective toilet
ESTINUTIED CONSTRUCrION COST
400 Highland Avenue
Salem MA 01970
(978) 741-2003
CONTRACTOR INFORMATION "�/
Name f/ieji�e/ /10,ry/6
Address IP-1 0,k- Sf• G./Arf1_e/d /fe ptea'd
Telephone-339- ,Ao3-ljr 6
Construction Supervisor's Lic# 0919'y12-
Home Improvement Contractor# r�6 3y5 S�
ARCHI'PECT/ENGINEER INFORbIA'rION
Name
Address
Telephone
Mass. Registration #
PERMIT FEE CALCULATION
Residential est. cost x $7/$1,000 + $5.00
Commercial est. cost x $1 U$1,000 + $5.00=
COMMENTS
The undersigned does hereby attest that all information stated above is true to the best
of my knowledge under the penalties of perjury
Signed
Date