13D GRISWOLD DR - BUILDING INSPECTION . EI`I'Y-O —
PUBLIC PROPERTY
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MAYOR 120 WAstiINGTfMJ StRfET 4 'yuty,MAbsnatt;st'rts 01970
of, 1t7.978.745.959E FAX 97&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: /3
--- -Property address:— - -
3 - G
Property Is located in a; Conservation Area Y/N Historic Distrkt YIN AL_
2.0 OWNERSHIP INFORMATION
2.1 Owner of Land
Name:
Address:
Telephone: 0 `� sqC7 Leh 07 —
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:
e Chimn'Gays
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Mail Permit to: o7g o77�nn
What is the current use of the Building?
Material of Building? If dwelling, how many units?
Will the Building Conform to Law? Asbestos?
e rmney uys
Architect's Name
Address and Phone Peabody.MA 01%0 ( )
Mechanic's Name
978-977-9900
Address and Phone
Construction Supervisors License# HIC Registration#
Estimated Cost of Project$.
Permit Fee Calculation
Permit Fee It _^ 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 build to the above stated
specifications. Signed under penalty of perjury
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