5D DEWEY DR - BUILDING INSPECTION JACKET _ EI=" 1 --
PUBLIC PROPERTY
DEPARTMEINT
KI%MERLEY DRIS:OLL
MAYOR Y 110 I30 WnswNamN S�nF��[ti�A11.1r,:rr ,
Wn.StncJiMl'IS 01970
IIi.:97&735-959S*FkL 978-740-98"
APPLICATION FOR THE REPAIR, RENOVATION, CONSTRUCTION.
DEMOLITION. OR CHANGE OF USE OR OCCUPANCY, FOR ANY EXISTING
STRUCTURE OR BUILDING
1A SITE INFORMATION
Location Name: Building:
Property Address_
Property Is located in a; Conservation Area Y/N Historic District Y/N
2.0 OWNERSHIP INFORMATION
2.1 Owner of Land
Name:
Address: S '�E� i L✓r ,
Telephone:
3.0 COMPLETE THIS SECTION FOR WORK IN FYIQTtur= BUILDINGS ONLY
Addition Existing
Renovation Number of Stories Renovated
Change in Use New
Demolition Existing
Approximate year of Area per floor (so Renovated
construction or renovation
of existing building New
Brief Description of Proposed Work:
�Tns��G� lox
P.O.Boa-4074— — -— --- --- -- . .
Mail Permit to: Pea od 9900 - - -
What is the current use of the Building?
Material of Building? If dwelling, how many units?
Will the Building Conform to Law? Asbestos?
The Chimney Guys
Architect's Name os
Address and Phone n . a M A n1 ocn
Mechanic's Name 978-977-9900
Address and Phone
Construction Supervisors License
�# HIC Registration#
Estimated Cost f Pro�$ O� Permit Fee Calculation
Permit Fee$ Estimated Cost X$7/$1000 Residential
-- __ Estimated Cost X$11/$100oCommercial — -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 buil a above stated
specifications. Signed under penalty of perjury X '✓�%%�
Date
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