3D GRISWOLD DR - BUILDING INSPECTION (2) EITrOF- - -
PUBLIC PROPERTY
DEPARTMENT
KI.\01FJLRY ORMAN 1
MAYOR 130 WASHINGTON SnRF ,•J.uaK MASSAOI{:SlTIS Ot970
APPLICATION FOR THE REPAIR. RENOVATION. CONSTRUCTION
DEMOLITION. OR CHANGE OF USE OR OCCUPANCY FOR ANY EXISTING
STRUCTURE OR BUILDIN .
1.0 SITE INFORMATION
Location Name: Building: 3-
----
Property Address: -- -- ------ _ _- - - - -- ----- --
3 - 0 G -
Property In located in a:Conservation Area YIN Historic District YIN
2.0 OWNERSHIP INFORMATION
2.1 Owner of Land `
Name:
Address:
Telephone: 43 7$ ,')•7 7 9 i ocl
3.0 COMPLETE THIS SECTION FOR WORK IN EXISTING BUILDINGS ONLY
Addition Existing
Renovation c/
Numb
er of
Stories Renovated
Change in U �/
9 � New
Demolidon Existing
Approximate year of Area per floor (sf) Renovated
construction or renovation
of existing building New
Bdef Description of Proposed Work:
The Chimney Guys
P.O. Box 4074
-- —_ 978=977-m0
Mail Permit to: - - - -
What is the current use of the Building?
Material of Building? B dwelling,how many units?
"a the Building Conform to Law?
The imn Asbestos?
Archi w s Name
Address and Phone ahody MA 01960
Pe _( )
Mechanic's Name
978-977-9900
Address and Phone
Constriction Supervisors License# HIC Registration#
Estimated Cost of Project Z c� PWMA as Calculation
Permit Fee$ Estimated Cost X$7/$1000 Residential
Estimated Cost XSf1/$joOOCommwdal---------
An Additional $5.00 is added as an
Administrative charge.
Make sure that all flelds are property 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
v � 5
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Y
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