7A GRISWOLD - BUILDING INSPECTION (2) What is the current use of the Building? M dweNkS tow many units? —
Maudd of Buildirg? Asbestos?
Wilt the Buikting Contbrm to Lwerulmney GUYS
Amhit ds Name
Address and PhorN Peabody VM
978-977-9900
Medtanio'e Name
Addren and Phone HIC Regbtratbn f
Consaudfon Supovisom License 0 -
Estimated Cad��—"�--- O'c> permit Fee CWC Wfon
Pen"It Fee S Estimated Cod X:71=1000 Residential
Estimated Cost X:111f1000 Cemnwda4-_ -
An Additional$5.00 in added as an
Administrative Burgs.
Make an that all fields an properly and legibly written to avoid delays In p oeesairg.
The undersigned doss hereby apply for a Building Peril to build to the above stated
speoUlcatkxrs. Signed under penalty of perjury
Date
0
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7! s v o d o
1 •I'll ! "�F r ' I
i UITY-UFNALE,M
PUBLIC PROPERTY
DEPARTNMNT
1.?. r`Niidltl 3 f i ;
I:I.�NER1Y tiwrr
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Nwroe 1�1iI.WUNGiBN t�?fieT•�!uu!lN+�uaasrYR0t9T0
11L•f'.,e.7iS.9S!!�F�1C f7e.7g9ey
APPLICATION FOR THE REPAIR. RENOVATION_ CONSTnr'MON
DIUMQUI M OR CHANGE OF USE OR QGQMAmN Fog ANy
STRUCTURE OR BUIL9 G
1.0 SITE INFORMATION
l.aeation Narnee - Buildlna
Property Addrs.a - - -
� -.A GA�o-e�
Property M loosgd ins;C0ra4rvstl0n Ares YIN 4,-- HWDft DkWd YM
To OWNERSHIP INFORMATION
11 Owner of Land '
Name: oej; A) Xr e4
addrac `J -i9 G��s c✓o/�
Telephone 3 ),L
3.0 COMPLETE THIS SECTION FOR WORK IN EYIBIWa 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
Wd Description of Proposed Work-
e sey uys. --- .
—- -— --- P.O. Rnr 4024 -
Mail Permit to: Peabody,MA 01%0
7R-977_9MIn