3A FLETCHER WAY - BUILDING INSPECTION EIT� TPULICPRP
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KIMBERLEY DRISCOLL -
MAYOR 120 WASMNGrON STREEr 0 Si^u MAAACHLSM-11S01970
741:979-74S•959S*fAX 978-740.9946
APPLICATION FOR THE REPAIR, RENOVATION. CONSTRUCTION.
DEMOLITION OR CHANGE OF USE OR OCCUPANCY_ FOR ANY EXISTING
STRUCTURE OR BUILDING
1.0 SITE INFORMATION
Location Name: Building: 3 -
Property Address: 3 _tq
property is located in a; Conservation Area Y/N Historic District Y/N
2.0 OWNERSHIP INFORMATION
2.1 Owner of Land _
[Address:
e: �A.0
phone:
3.0 COMPLETE THIS SECTION FOR WORK IN EXIQTING BUILDINGS ONLY
Addition Existng
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:
X, - 0-M I` / , `
The Chimney Gu s
_- . ---------- --'--Peabody, MA-i960
Mail Permit to:
What is the current use of the Building?
Material of Building? If dwelling, how many units?
Will the Building Conform to Law? Ghim...... Guy,*- Asbestos?
Architect's Name P O Box 4074
Address and Phone Peabody,MA 01960
Mechanies Name
Address and Phone
Construction Supervisors License# HIC Registration#
Estimated Cost off�Project Permit Fee Calculation
Permit Fee$ Estimated Cost X$7/$1000 Residential
Estimated Cost X$11/$1000 Commercial
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 build to the above stated
specifications. Signed under penalty of perjury
Date
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