4C DEWEY DR - BUILDING INSPECTION JACKET EI`I'Y-OF SALES --
PUBLIC PROPERTY
DEPARTMENT T
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91maFJUEY 0 ..OLL
MAYOR 130 WAsHjNGw*S-mEET•SmEK MA bsAci1l:svrrS 01970
TFs:978-74S-959S 0 FAX 973-740.960
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APPLICATION FOR THE REPAIR .3 .a,
,RENOVATION. CONSTRUCTION.
DEMOLITION OR CHANGE OF USE OR OCCUPANCY, FOR ANY EXISTING
STRUCTURE OR BUILDING
1.0 SITE INFORMATION
Location Name: /7, c Building:
Property Address: y-C /,�-,ems O`
Property is located in a; Conservation Area YIN Historic District YIN %J
2.0 OWNERSHIP INFORMATION
2.1 Owner of Land _
Name: 2�xcnn /fie 6��1C
Address: !�_ r / � , > - G✓(-.
Telephone: 9 78- 74S -- G k`-//
3.0 COMPLETE THIS SECTION FOR WORK IN FxtaTING BUILDINGS ONLY
Addition Existing
Renovation �>o 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:
/lcr,o� c_ha5� cove! C Cr
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A4o.
The Chimney Guys
-- - -Peabody-,MA-_01%0. —- - ---- - -
---- --- 978-977-9900
Mail Permit to: -----
What is the current use of the Building?
Material of Building? If dwelling. how many units?
Will the Building Conform tIFJ@V-%i„«:, G lids Asbestos?
Architect's Name P.O. Box 4074
Address and Phone Peabody, MA 01960
Mechanic's Name
Address and Phone
Construction Supervisors License# HIC Registration#
Estimated Cost of Project$ U o Permit Fee Calculation
Permit Fee$ 5 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 properly and legibly written to avoid delays in processing.
The undersigned does hereby apply for a Building Permit to build to the above stat
penalty of perjury X
specifications. Signed under p nY p 0 ry
Date 2z o7
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