1A GRISWOLD AVE - BUILDING INSPECTION What is the current use of the Building?
Material of Building? If dwelling, haw many units?
Will the Building Conform to Law? Asbestos?
Architect's Name
Address and Phone
Mschanids Name
Address and Phone �O �� yd7`l y/8 Construction Supervisors License X HIC Registration
Estimated Cost of Project iZ,,Z 0 0, Permit Fee Calcutation
Permit Fee$ Estimated Cost X S7/f1000 Residential
Estimated Cost X$11/$1000 Commercial An Additional $5.00 is added as an
Administrative charge.
Make sure that all fields are property and legibly written to avoid delays in processing.
The undersigned does hereby apply for a Building Permit to b ' to the above stated
specifications. Signed under penalty of perjury
Date ,
IV
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- CITY`oFgALEN —
��� PUBLIC PROPERTY
DEPARTMENT
/:1\OIERLfiY D�lSCWJ.
MAYOR 130 W/ASMN TnN bnWUr 0 yur'x MAisnOKl:SlTIS 01970
Tm-9!&743-959S•FAx:976740-96N
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: / GriStwa� T�
Property is located in a; Conservation Area Y/N Historic District YIN
2.0 OWNERSHIP INFORMATION
2.1 Owner of Land _
Name: t�
Address: /_
Telephone: 9 e�-- �� f
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 I New
9def Description of Proposed Work:
— - Mail Permit to: �sLL l�'sz
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