11A GRISWOLD AVE - BUILDING INSPECTION What is the current use of the Building?
Material of Building? If dwelling.how many units?_--
aw Asbestos?
Win the Building Conform to a The Zhrmney uys
Architeds Name
Address and Phone 978-977-9900
Mechanids Name
Address and Phone HIC Registration#
Construction Supervisors License#
Permit Fee Caksulatktn
Estimated Cost of Projed Z — Estimated Cost X$7/$1000 Residential
Permit Fee i -
- - Estimated Cost Xit11$1000CammerGa4--- - -
- - - - 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 X
Date S 2 "�
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PUBLIC PROPERTY
DEPARTME►�1T
KING&EXEY DRISCO1 L
%(AYOe 130 WAswNCIEW `,
5ALL�4qAstAan;stl'rs0t970
141:MUS-%95 1 FAR,976740.9W
APPLICATION FOR THE REPAIR RENOVATInN CONSTRUCTION
DEMOLITION. OR CHANGE OF USE OR OCCUPANCY FOR ANY EXISTING
STRUCTi7IZE OR BUILDING
1.0 SITE INFORMATION
Location Name: e-fr.+!i _ Building:
- Property Address:--
G�� -
Properly is boated in a;Conservation Area YIN ✓ Hlatarlo Dlstrid YM
2.0 OWNERSHIP INFORMATION
2.1 Owner of Land
Name:
Address:
/I- 1--9 (sAA`a�
Telephone: 9 7 -) -qcl,00
3.0 COMPLETE THIS SECTION FOR WORK IN 7Vstorles
NGS ONLY
Addition g
Renovation !� Number ated
Change in Use /DemolitiongApproximate year of Area per floatedconstruction or renovation
of existing building
B&J Description of Proposed Work:
P.U. Boa 4074 -- — - - -
Mail Permit to: ea ody,MA 01%0 - -