15D FILLMORE RD - BUILDING PERMIT APP Crr r oF-8ALEN
PUBLIC PROPERTY
DEPARTMEINT
120 WWUNGUM Snwxr*&kuiK M&MA0iL$&M 01970
14s M7454M PAM 976-740.960
APPLICATION FOR THE REPAIR RENOVATION. CONSTRUCTION
DEMOLITION, OR CHANGE OF USE OR 9COMANCYs FOR ANY EXISTING
STRUCTURE OR BUILDING
1.0 SITE INFORMATION
Location Name: /' ��M o-n Cr Building:
Property Address: -
Property is Iocated in a;ConservatIon Area Y/N /J Historic District Y/N -J
2.0 OWNERSHIP INFORMATION
2.1 Owner of Land
Name:
Address: r C,
Telephone: /�78 77 /`�� (:�
3.0 COMPLETE THIS SECTION FOR WORK IN E7(18[IWL; BUILDINGS ONLY
Addition Existing
Renovation Number of Stories Renovated
Change in Use Now
Demolition Existing
Approximate year of Area per floor (sf) Renovated
construction or renovation
of existing building New
add Description of Proposed Work: )
The Chimney Guys
U.. AdhOTA
-- — -
�_ eslrady,MA 03966- - --- ---- '
----- Mail Permit to: 978-977-9900
What is the current use of the Building?
Material of Building? if dwelling.how many units?
will the Building Conform to Law? Asbestos?
The Chimney Guys
A chiteds Name
Address and Phone
Mechanles Name 978-977-9900
Address and Phone
Construction Supervisors Ucense# e C alcuRe9 M #
Estimated Cost of Projed$ 0 � �O Permit Fee Calarlafbn
Permit Fee S Estimated Cost X$7/$1000 Residential
-_—_- Estimated Cost X S41/f1000 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 77bulld t he above stated
specifications. Signed under penalty of perjury
Date �;; S
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