1D GRISWOLD DR - BUILDING INSPECTION EI`Iy-OF AL —
PUBLIC PROPERTY
DEPARTMENT
KmawtLEY DRISCOLL
MAYOR 120 WASHING ON STREET•SALEK MASSAC31I I'M 01970
1E1978-745-9S9S 0 FAx:978.740.9846
APPLICATION FOR THE REPAIR; RENOVATION CONSTRUCTION,
DEMOLITION OR CHANGE OF USE OR OCCUPANCY FOR ANY EXISTING
STRUCTURE OR BUILDING
F
ORMATION
me: / 0 Gr Building:
ress: l— (,r 7S v 6 id dr
Property is located in a; Conservation Area Y/N t.J _Historic District Y/N
2.0 OWNERSHIP INFORMATION
2.1 Owner of Land _
L
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3.0 COMPLETE THIS SECTION FOR WORK IN EXISTING BUILDINGS ONLY
Addition Existing
- -Renovation ✓ -Number of-[Sttories--Renovated
Change in Use / New
Dariciit'son Existing
Approximate year of Area per floor (sf) Renovated
construction or renovation New
of existing building
Brief Description of Proposed Work:
Y
Mail Permit to Gr �}oX
7
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 6775 t s �y 7 7
Mechanic's Name AeT- Z
Address and Phone �o�n �d7V �06 T��4
Construction Supervisors License# HIC Registration#
Estimated Cost Project$ c--P-900 , 0 Permit Fee Cak ulation
Permit Fee$ Estimated Cost X$7/$1000 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 bull t6 the above stated
specifications. Signed under penalty of perjury X
Date
of
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