3C FLETCHER WAY - BUILDING INSPECTION What is the current use of the Building?
Material of Building? If dwelling.how many units?
Will the Building Conform to Law? Asbestos?
Architect's Name
Address and Phone P.O. Box 4074 ( )
Mechanic's Name Peabody,MA 01960
Address and Phone
Construction Supervisors Licqnse# HIC Registration#
Estimated Cost of Project4e;3 C-?'It> Permit Fee Calculation
Permit Fee$ Estimated Cost X$71$1000 Residential
Estimated-Cost-X$1 /$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 bui o the above stated
specifications. Signed under penalty of perjury
Date
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PUBLIC PROPERTY
DEPARTNI&NT
F:I�MERI.EY ORISCOLL
MAYOR 120 WAWING w SnLEEr YAItt;MAssACHt;serrs Ot970
TEL 973-74S-959S FAx 97&740.9846
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:
Property Address:
Property is located in a;Conservation Area Y/N Historic District Y/N
2.0 OWNERSHIP INFORMATION
2.1 Owner of Land
Name:
Address: -3-C
Telephone:
3.0 COMPLETE THIS SECTION FOR WORK IN EXISTING BUILDINGS ONLY
Addition Existing
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: /
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Mail Permit to: " 0° e,?OX y67�