1B HART WAY - BUILDING INSPECTION (2) PUBLIC PROPERTY
DEPARTMENT
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APPLICATION FOR.THE REPAIR.RENOVATION.:CUNSTRUCTION
DEMOLITION, OR CHANGE OF USE OR OCCUPANCY FOR ANY EXISTING
STRUCTURE OR BUILDING
1.0 SITE INFORMATION
Location Name: P;c,K A,'J PA C K Building:
Property Address: ' _ (5 K A(zT. to fi
Property is located in a; Conservation Area Y/N ) Historic District Y/N
2.0 OWNERSHIP INFORMATION
2.1 Owner of Land
Name: 8 _ Wen--ear
Address:
/ /3 gee aT WA cb.
Telephone:_ -37X
3.0 COMPLETE THIS SECTION FOR WORK IN EXtSIIIlIG BUILDINGS ONLY
Addition CNew
_-..___.
Renovation Number of Stories
Change in Use a
Demolition
Approximate year of Area per floor (sf)
construction or renovation
of existing building
Brief Description of Proposed Work:
Riepir-;ce Old ,F,eer.,�Rb Pjrz.ep1jce St�,sTen� wiTh
gyp _
Mail Permit to: Peabody,MA QFMO
what is the current use of the Build)ng3; R i«•, ,
Material of Building? If dwelling,how many units?_._—_
will the Building Conform to Lawyhe (`n--"rA— Asbestos?
[himn
Architect's Name P.O.Box 4074
Peabody,MA 01960
Address and Phone _
Mechanic's Name --
Address and Phone -.
Construction Supervisors License _ HIC Registration#
Estimated Cost of Projed$ Permit Fee Calculation
Permit Fee$ _ Estimated Cost X$71$1000 Residential
Estimated Cost X$11J$lGoo 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
Date
0
y, N
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