9D FILLMORE RD - BUILDING INSPECTION CrrroF-
PUBLIC PROPERTY
DEPARTMENT
IG.�OIEILfiY D�ISCOLL � ��t '/
�Gral 130 WAUUN=M b%MEW 0 Asti-s 01970
I%L'97474SM"0 PAZ M740-98K
APPLICATION FOR THE REPAIR. RENOVATION CONSTRUCTION
DEMOLITION. OR CHANGE OF USE OR OCCUPANCY FOR ANY EXISTINGI
STRUCTURE OR BUQ.DIIN .
1.0 SITE INFORMATION
Location Name: Building:
--
Property l•located in a:ConswvaWn Ares YIN A / Hlstorlo Dlsfrbt Y/N
2.0 OWNERSHIP INFORMATION
2.1 Owner of Land
Name: n
Address:
Telephone: Octep %7� 77_ 9
3.0 COMPLETE THIS SECTION FOR WORK IN FY1ATtura BUILDINGS ONLY
Addition Existing
Renovation Number of
Stories
s Renovated
Change in Use Now
Demolition Existing
Approximate year of Area per floor (sf) Renovated
construction or renovation
of existing building New
adef Description of Proposed Work:
The Chimney Guys
Peabody-,-�4A A1%0-- -
-- Mail Permit to: 97 ' - - - - -
What is the current use of the Building?
Material of BuildingT If dwelling,how many units?
Win the Building Conform to Law% G „o., � Asbestos? --
Architects Name P.O. Box 4074
Peabody, MA 01"
Address and Phone
Mechanies Name
Address and Phone
Constriction Supervisors license S HIC Registration 0
Permit Fee CalaiWW
Estimated Cost of Project S dC5` d�
Estimated Cost X S7IS1000 Residential
Permit Fee$
__-- Estimated Cost X$11/S1000 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 bu the above stated
specifications. Signed under penalty of perjury
Date
�I
78
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