11D GRISWOLD DR - BUILDING INSPECTION CITY-0 —
PUBLIC PROPERTY
DEPARTMENT
1:1sWElLLEY DW5l:ULL` `
MAYOR ✓ .! X / 120 WAsHiNGTON STREET 'v / �" K MvtAoit;stI's 01970
Tq_-978-74S-9S9S 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: Building: /-Q
Property Address'. —
Property is located in a;Conservation Area Y/N AJ Historic DisVIct YM
2.0 OWNERSHIP INFORMATION
2.1 Owner of Land _
Name: C , _ C
Address:
r/ - /J VE
Telephone: 9 ja q`7R - �F7Sa
3.0 COMPLETE THIS SECTION FOR WORK IN FyISTtNr. 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
Eldd Description of Proposed Work:
Mail Permit to:
eabody,MA 014b0 - -----
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 nYs
Architect's Name
Address and Phone v ba ft MA 01%0 ( )
Mechanic's Name 978-977-9900
Address and Phone
Constriction Supervisors License# HIC Registration#
Estimated Cost of Pro'ect$_Z�20:2r' Permit Fee Calculation
Permit Fee$ Estimated Cost X$741000 Residential
Estimated Cost-X$1141000-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 X —
Date
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