1B FLETCHER WAY - BUILDING INSPECTION (2) What is the current use of the Building?
Material of Building? If dwelling, how many units?
Will the Building Conform to Law? Asbestos?
The �maey
Architect's Name
Address and phone Peaho ft. MA 01960 ( )
Mechanic's Name 978-977-9900
Address and Phone
Construction Supervisors License# HIC Registration#
Estimated Cost of Project$ /000 Permit Fee Calculation
Permit Fee $41/— Estimated Cost X$71i1000 Residential
Estimated Cost X$11/$1000 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
�P/ermit to buil to the above stated
specifications. Signed under penalty of perjury X
Date / 3
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PUBLIC PROPERTY
DEPARTMENT KII%ME,L /�/�
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Murat t 20 WASMNGWW N MEFr.•"LUK Sl,%ssuoH&;stl-rs Ot970
Ts-976.745.9S" FNr:975.740.96"
APPLICATION FOR THE REPAIR. RENOVATION, CONSTRUCTION,
DEMOLITION, OR CHANGE OF USE OR OCCUPANCY, FOR ANY VaSTING
STRUCTURE OR BUILDING
1.0 SITE INFORMATION
Location Name: a4Ajyv <,� P Building:
Property Address.. '
Property is located in a;Conservation Area YIN Historic District Y/N
2.0 OWNERSHIP INFORMATION
2,i Owner of Land
Name: 12)
Address:
Telephone:
3.0 COMPLETE THIS SECTION FOR WORK IN EX181ING BUILDINGS ONLY
Addition Existing
Renovation 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:
Mail Permit to: