3C GRISWOLD DR - BUILDING INSPECTION RK
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PUBLIC PROPERTY
DEPARTMENT
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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: 3 C
-- — -
3 c . C'A;-0 AA0'
Property Is located In a;Conservation Ares Y/N Historic District Y/N
2.0 OWNERSHIP INFORMATION
Z1 Owner of Land
Name:
Address:
3C
Telephone: 13)Fr _ ra-77 -C1 loQ�
3.0 COMPLETE THIS SECTION FOR WORK IN EXULTMI 3 BUILDINGS ONLY
Addition Existing
Renovation Number of Stories Renovated
Change in Use / New
Demolition Existing
Approximate year of Area per floor (sf) Renovated
construction or renovation
of existing building New
Brief Description of Proposed Work:
The Chimney Guys
P.O. Box 4074
978--977-9900-------- - - -
- Mail Permit to: - - -
What is the current use of the Building?
Material of Building? if dwelling.dlli how many units?__.___—
win the Building Conform to Law? The GhiffiROY C-*Ys- Asbestos?
Architect's Name P.O. Box 4074
60
Address and Phone Peabody, MA 019 ( j
Machanles Name
Address and Phone
Construction Supervisors license 0 HIC Registration 0
Permit Fee Cala Won
Estimated Cost of Project Sam a
Estimated Cost X$7/51000 Residential
Permit Fes S
— - - - - - -- Estimated Cost X$41/$1000 CornmsrcI8t --
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
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