11B GRISWOLD DR - BUILDING INSPECTION TR
PULICRTY
DEPARTIVIFNT
KimsmEV DiusCULL
MAYOR 120 WASHING ON S-MEEr*SALk21,.MASSAC3R;5tT13 01970
T a1,978-745-9595 4 F=978.740.98"
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:
Property-Address--,/l=��—r�:z�� --
Property is located in a; Conservation Aree Y/N f-J _Historic District Y/N nJ
2.0 OWNERSHIP INFORMATION
2.1 Owner of Land
LName:ess: f/� � ��phone: 9" 5,9 L/ d�3C7
3.0 COMPLETE THIS SECTION FOR WORK IN ExIaTM 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 INew
Brief Description of Proposed Work::
V`E�i� .
r
The Chimney Guys
Box
et060 - - -----
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 ChimneY UuYs
Architect's Name .,
Address and Phone Peabody MA 01960 ( )
978-977-9900
Mechanic's Name
Address and Phone
Construction Supervisors License# HIC Registration#
Estimated Cost of Pro eat$ ,�c�J c5lo Permit Fee Calculation
Permit Fee$
Estimated Cost X$7/$1000 Residential
---- —-- — -- Estimated Cost-X$14l$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 bull to the above stated
specifications. Signed under penalty of perjury
Date
y 3 N
N
d W r
01 .y
b M�
ti
r y 4
_. - — - - -Ann-_ - -'