13A GRISWOLD AVE - BUILDING INSPECTION What is the current use of the Building?
Material of Building? If dwelling.how many units?
-
win the Building Conform to Law?
Asbestos?
Architeas Name
Address and Phone
Mechanic's Name
Address andPhone,4 �rO�
Construction supervisors License# HIC Registration p
Estimated Cost of Project$ L C° Permit Fee Calculation
permit Fee $ Estimated Cost X$7/51000 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 b the above stated
specifications. Signed under penalty of perjury
Date , /C57,77
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�d�- PUBLIC PROPERTY
"a DEPARTbIFINT
MAYM 130 WASMNGTON h MW7 Sukx MA\SAOIlShTR 01970
lti 97e-745-gS" 0 FAx:97s.740.9/46
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: / , , G/ _ Building:
Property Address: // 7 1-q o�--
Property Is located in a; Conservation Area Y/N�_Historic District YIN
2.0 OWNERSHIP INFORMATION
2.1 Owner of Land _
Name: 0.0
Address:
Telephone:
3.0 COMPLETE THIS SECTION FOR WORK IN EYrAZING BUILDINGS ONLY
Addition Existing
Renovation Number of Stories Renovated
Change in Use .2 New
Demolition Existing
Approximate year of Area per floor (sf) Renovated
construction or renovation
of existing building New
Brief Description of Proposed Work: l
Mail Permit to: / on 2�-