7D GRISWOLD DR - BUILDING INSPECTION 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 T. Chimney Guys
Box 4074
Address and Phone
Mechanic's Name
Address and Phone
Construction Supervisors License# HIC Registration#
Estimated Cost f Project$ 1 7� Permit Fee Calculation
Permit Fee$ — Estimated Cost X$741000 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 a above stated
specifications. Signed under penalty of perjury
Date
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O O� 5 7
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PUBLIC PROPERTY
DEPr1RT1JEI�1T
KINISHU hlf DRISCOL.
MAYOR 'W WAswN mN SnFEr# '
„LEK MAssncxt;st-rrs 01970
TEL-978-745-9595*TAx 97&740-9846
APPLICATION FOR THE REPAIR, RENOVATION, CONSTRUCTION,
DEMOLITION, OR CHANGE OF USE OR OCCUPANCY, FOR ANY EXISTING
STRUCTURE OR BUKDING
1.0 SITE INFORMATION
Location Name: Building:
Property Address. 0
Property is located in a; Conservation Area Y/N Historic District YIN
2.0 OWNERSHIP INFORMATION
2.1 Owner of Land
Name:
Address:
Telephone:
3.0 COMPLETE THIS SECTION FOR WORK IN EXISTING BUILDINGS ONLY
Addition Existing
Renovation Number of Stories Renovated
Change in Use 2 New
Demolition Existing
Approximate year of Area per floor (so Renovated
construction or renovation
of existing building New
Brief Description of Proposed Work:
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The Chimney Gays
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Mail MA n1g6Q --
Mail Permit to: 978-977-9900 -