2B HART WAY - BUILDING INSPECTION -CITY-OF-S7ALETNr-
PUBLIC PROPERTY
DEPARTMENT S�RLI �KmWEx usu.6Y ocu
MAYos 130wwskum wbr%mr•
'[41978-745-95"0 PAX 976-740.984
APPLYCATION FOR THE REPAIR RENOVATION, CONSTRUCTION.
DEMOLITION, OR CHANGE OF USE OR OCCUPANCY, FOR ANY EXISTING
STRUCTURE OR BUILDING
1.0 SITE INFORMATION
Location Name: g r _- Building: Q
Property Addresr. a � .
Properly is located in a;Conservation Area Y/N Historic Dlatrld Y/N
2.0 OWNERSHIP INFORMATION
2.1 Owner of Land
Name:
Address:
Telephone: '971
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 (sf) Renovated
construction or renovation
of existing building New
9def Description of Proposed Work:
� � I
The
Chimney Cuvs
P.O. Box 4.074_ --- -- . -- -- ._
Mail Permit to: 97s_o77_9900
What is the current use of the Building?
Material of Building? If dwelling, how many units?
will the Building Conform to Law? 07 Asbestos?
ct'
Archites Name 'Shy f;hir f u
Box 4t174
Address and Phone Peabody,
Mechanic's Name 978 977 99nn
Address and Phone
Construction Supervisors License# HIC Registration#
Estimated Cost of Project Permit Fee Calculation
Permit Fee i Estimated Cost X$71$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 penury X
Date 3
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