2D HART WAY - BUILDING INSPECTION (2) Er w OFg .Eb
PUBLIC PROPERTY
DEPAR'I11dENT
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NAMOt 130 WAMLNG air SMEET•SiurM.Yuuotsrrs 01970
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APPLICATION FOR TRZ REPAIR. OVATIOM CONcTtatrrr- ON,
DO OLITIO&OR CHANGZ OF USZ OR OCCUPANCY, FOR ANY EXISTINQ
STRUCTURZ OR WELDING
a wm INFORMATION '
Locadon Name: Building: o?O
---
av ��- w
Ropwly In located In a:Coruervation Mee YIN HIsioAo DleMd YIN
4.0 OWNERSHIP INFORMATION
11 Owner of Land _
Name: �Q
Address:
Telephone:
3.000MPLETE THIS SECTION FOR WORK IN E7WMNa BUILDINGS ONLY
Addition Existing
Renovation Number of Stories Renovated
Change in Use / New
Demolition Existing
Approximate year of Area per floor NO Renovated
construclion or renovation
of existing building New
add Description of Proposed Work: _
The Chimney Guys
Peabody, MA-01.,90 -------. ... -.. -.. - . ... -
-- -Mail Permit to: _ _ - - -
V"is"uurent use of the Building?
Material of Building? If dwelling,now MON units?
Wilt tits Buildup Contbrnt to Lwffle Asbestos?
Aron tbas Name
Address;and Phor>• Peabody MA 01960 ( )
978-977-9900
Maohank's Name
Address and Phone
Construe gupwvisors License B HIC Repbtratbn 0
Estimated Cost of Project i aooa� Permit Fee Calwmtiort
Permit F«f Estimated Cost X$711111000 ReNdentiet
Estimated Cost X i11/:100A Commercial---
An Additional$5.00 Is added «an
Administrative Charge.
Make sure that all fields are property and leyibb*Ttftn to avoid delays In processing.
The undersigned do"hereby apply for a Building;:=
specitiCationc Signed under penalty of perjury
Date
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