5A HALSEY WAY - BUILDING INSPECTION What is the current use of the Building?
Material of Building? if dwelling. how many units?
Will the Building Conform to L')At CbimaeY-C y Asbestos?
Architect's Name ' P.O. Box 4074
Peabody, MA 01.960
Address and Phone
Mechanic's Name
Address and Phone
Construction Supervisors License# HIC Registration#
Estimated Cost of Project S-a?a0_0 Permit Fee Calculation
Permit Fee i Estimated Cost X$7/$1000 Residential
Estimated Cost X$11411000 Commerclat 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 Perm' build to the above stated
specifications. Signed under penalty of perjury X
Date
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PUBLIC PROPERTY
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MAYOR 130 WASMNGTom b,.TR T•SAL"k.UASUa4Lstlis 0t970
TIM 974745-9S"*FAX 97S-740.9/46
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: 79
Property Address-.
Property Is located in a;Conservation Area Y/N Historic District Y/N
2.0 OWNERSHIP INFORMATION
2.1 Owner of Land
Name: _
Address:
5-
Telephone: p
3.0 COMPLETE THIS SECTION FOR WORK IN EXISTING BUILDINGS ONLY
Addition Existing
Renovation Number of Stories Renovated
Change in Use N
Demolition Existing
Approximate year of Area per floor (an Renovated
construction or renovation
of existing building New
Brie( Description of Proposed Work:
--- - - Mail Permit to: -- -- —