5B GRISWOLD DR - BUILDING INSPECTION Erry-OF AM1 —.
PUBLIC PROPERTY
DEPARTMENT
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MAYOR 12A WA sHiNGTON STRFFr#SAu�K X%AACHLUXM 01970
143:978-735.9595•FAIL 978-740.9946
APPLICATION FOR THE REPAIR, RENOVATION CONSTRUCTION.
DEOLITION OR CHANGE OF USE OR OCCUPANCY FOR ANY EXISTING
M
STRUCTURE OR BUILDING
1.0 SITE INFORMATION
Location Name: c l<MA ✓ PFl Q K Building: -/3
Property Address:
S o G rz�s c
Property is iocated in a;Conservation Area Y/N Historic District Y/N
2.0 OWNERSHIP INFORMATION
2.1 Owner of Land
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3.0 COMPLETE THIS SECTION FOR WORK IN EXISIM BUILDINGS ONLY
Addition Existing
Renovation Number of Stories Renovated
Change in Use c;2, New
Demolition Existing
Approximate year of Area per floor (sf) Renovated
construction or renovation New
of existing building
Brief Description of Proposed Work:
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SuPQI'O1Z 5� 5Te / /✓e � l, � Se c�veF2
The Chimney Guys The Chimney Guys
P.O. Box 4074
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----Teabody-,MA 01960-_.
Mail Permit to: 9'h-977-99ot)
What is the current use of the Building?
Material of Building? If dwelling. how many units?
Will the Building Conform to Lawrhvehinjury ev
Asbestos?
Architect's Name P nl Ray 411174
Address and Phone Peabody,MA 01960
978-977-9900
Mechanic's Name
Address and Phone
Construction Supervisors License# HIC Registration#
Estimated Cost of P*ect$ i � Permit Fee Calculation
Permit Fee$ Estimated Cost X$7/51000 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 build to the above stated
specifications. Signed under penalty of perjury
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