5A DEWEY DR - BUILDING INSPECTION JACKET CITY-OF
F --
PUBLIC PROPERTY
DEPARTMEINT
ymal 42y DRISCOLL .
MAYOR 12D WASHING"S-Mk�r i'S LLXK%(ASSA6/4SkrM 01970
141 978-74!-MS*'FAX 971L740.9946
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: Building:
Property Address: C— /q
Property is located in a; Conservation Area YIN_�L Historic District Y/N N
2.0 OWNERSHIP INFORMATION
2.1 Owner of Land _
Name:
Address:
Telephone: 97fr- 7yS �� o-J;
3.0 COMPLETE THIS SECTION FOR WORK IN t=YiSTtNr: BUILDINGS ONLY
Addition Existing
Renovation Number of Stories Renovated
Change in Use New
Demolition Existing
Approximate year of Area per floor (sn Renovated
construction or renovation
of existing building New
Brief Description of Proposed Work:
.6 Nicvc-.,
C ti� se c o v�r CA,r.-y Crr)
The Chimney G s
P.O. Ray 4fl7A
--
----------- Pea6ody,1`IA41960
=9900 .
Mail Permit to:
What is the current use of the Building?
Material of Building? If dwelling, how many units?
Will the Building Conform to Law? 1hp(9himney GUp Asbestos?
Architect's Name P.O.Box 4074
Address and Phone Peabody,M
A U1V6U
978-977-9900
Mechanic's Name
Address and Phone
Construction Supervisors License# HIC Registration#
Estimated Cost of Project$ 9 7S. ` '-) Permit Fee Calculation
Permit Fee$ 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 t the above stated
specifications. Signed under penalty of perjury X G!��
Date Z 6
Y
1V
N
a
N 9 4
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