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9B GRISWOLD DR - BUILDING INSPECTION - k-I PUBLIC PROPERTY DEPARTMENT KI%03FJU.EY DRISCOLL MAYOR 1?0 WASHIN4TON STREET*$.VZ:Iy„\(ASyACH1:56T15 01970 1Ft 978-745-9595*FAx 978-740.9846 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: FoG,",q,, ilAQ.Ie 4a,r.NOo5 Building: Property Address: �` (3 & Z1;iwA (S Property Is located in a; Conservation Area Y/N w/ Historic District Y/N 4- 2.0 OWNERSHIP INFORMATION 2.1 Owner of Land e Name: A' e G.J eaf A Address: 9 -a G-kj!5WPID 101'r-kM4.4) PAek Telephone: _ 3.0 COMPLETE THIS SECTION FOR WORK IN EXISTING 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 grief Description of Proposed Work: dome/eTe PIHGeA-�efit' off' PRe -VAB Mail Permit to: 7Xe CAZAi ,P u 6-w -g P© Pvox V079 �ahoa� M V 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 Mechanic's Name 62 e D Address and Phone PC' 160 y ^^ Otgh - ��9�� Construction Supervisors License# HIC Registration# Estimated Cost of ojec`t$ aid 8`)� Permit Fee Calculation 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 uild to the above stated specifications. Signed under penalty of perjury X Date 11 .13_o -K ... N N 9 b L 0 4I °o L v F. awe > u a u r C6 i