9C GRISWOLD DR - BUILDING INSPECTION CITY-OF3-Xt --
PUBLIC PROPERTY
DEPARTMENT
MAYOR t 20 WAstuHcmN a'�;r S•LEK N.vhsAo+LsnllS 019i0
T EU 978.745 MS 6 FAY:97.8-740-9946
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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: _ (J
PropertyAddress:—q
Property is located in a; Conservation Area Y/N Historic District Y/N
2.0 OWNERSHIP INFORMATION
2.1 Owner of Land _
Name: nn Address: Y C
Telephone: 97 7 J— 5-73
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 (so Renovated
construction or renovation
of existing building New
Brief Description of Proposed Work:
The Chimney Guys
a
-----
Mail Permit to: 978-977-9900
What is the current use of the Building?
Material of Building? If dwelling,how many units?
Will the Building Conform to Law? Asbestos?
The unney uy
Architect's Name
Address and Phone Peabo� MA 01960 ( )
978-977-9900
Mechanic's Name
Address and Phone
Construction Supervisors License# HIC Registration#
Estimated Cost of Project$ A-2 Oct Permit Fee Calculation
Permit Fee$
Estimated Cost X$7/$1000 Residential
— — - -------Estimated-Cost-X$11/$1000-Commerci2i -- —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 /� ✓
Date /_, g_o0 7
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