2C FLETCHER WAY - BUILDING INSPECTION (003) EPrroF
PUBLIC PROPERTY
DEPARm,,LNT
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APPLICATION FOR THE REPAM RENOVAnoN CCWMUAnMr4,
DE.NAOLI'I'ION,OR CHANGE OF USE OR OCCUFALgCv_ Fog •Ny M ffWG
STRUCTURE OR BUII.DIN(3 �'
1.0 SM INFORMATION
Location Nam �r,� Buildlr>a
pity ---- ---- -- - -- - ,- . . ----� _--- -
Property ie be ded In a;Cwmwvadon Arse YM Historb Dis W YM
2.0 OWNERSHIP INFORMATION
11 Owner of Land _
Namr. G -Tck,
J_ rls+2e
Address.
TeNptlorle: c-7c->
ffRonavadon
IS SECTION FOR WORK IN E><ISIWQ BUILDINGS ONLY
Existing
Number of Stories Renovated
r
ange In Use Newmolition ��gproximate year of Area per floor(st) Renovated
struction or renovation
of existing building New
Arid Description of Proposed Work:
--- —- ---Mail Permit to: --- - -
What is tl+e CUMM use of the Budding?
Materiel of Buidrg? 0dwelting,Now many units?
The Asbestos?
We00 Buidrg Cor&M b law7
ig
P.O. Box 4074
Argdads Name eabody, MA 01960
AOdrMs and Phone _ _
Maohanlaa Name
Addren and Pha+a
Consbtktion Supervisors ic"— HIC Regatration
EstYnatad Cost of Pralsat ��FN Cakulallat
Permlt Fee= Estimated Cost X$7/$1000 Residential
- --- - Es*rAWd Cost X$41/:100A Commerds4---An Additional s6A0 is added as an
Adminlatrs"ahargs.
Make acre that alt fleldn an property and Ispimy wrilten to avoid delays In Proeseatrng.
The undersigned does hereby apply fbr a Building ParrM to b ul the above
spoc&adom Signed under penalty of PwPJIY
Date 4
zY
A � �