1B GRISWOLD DR - BUILDING INSPECTION - GITY-OFSALE;M
PUBLIC PROPERTY
,y DEPAR'I1b &NT
%IAYae 130 WARUNGrriN s`r =`i
1wsrk HwcsAottstllS 01970
74a:9 WUS-9S"0 FAX 97L740-"46
APPLICATION FOR THE REPAIR 1 '"VATION CONSTRUCTION
DEMOLITION. OR CHANGE OF USE OR OCCUP NCY FOR ANY EXISTING
- STRUCTURE OR BUILDING
1.0 SITE INFORMATION "
Location Name: Building:
- Property Address:
/ 13
Property b bested in a: Conservation Aroe YIN Historic District YIN
2.0 OWNERSHIP INFORMATION
2.1 Owner of Land `
Name:
Address:
/ -- (mac,
Telephone: Gj W- 9 � oC>
3.0 COMPLETE THIS SECTION FOR WORK IN EXISTING BUILDINGS ONLY
Addition Existing
Renovation Number of Stories, Renovated
Change in Use a Now
Demolition Existing
Approximate year of Area per floor (sf) Renovated
construction or renovation I
of existing building New
Bdef Description of Proposed Work:
Mail Permit to: Peabody, MA ulvou
What is the Current use of the Building? if dwelling,how many unit ?
Material of Building? Asbestos?
"it the Building Conform to L.avti
Archited's Name
Address and Phone Peabody,MA 01960
978-977-9900
Mechanic's Naar
Address and Photo HIC Registration 4
Construction Supervisors L MWG 00 Permit Fee Calculation
Estimated Cost of Projed
Permit Fee S� Estimated Cost X$7/$1000 Residential
Estimated Cost X i11/51000 Commerda4--- -
- - An Additional$5.00 is added as an
Administrative duarg&
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 :2
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