3A HART WAY - BUILDING INSPECTION EI'PrOF
PUBLIC PROPERTY
' DEPARTME►NT
KI..%GWJ-EV DRLSCOU
MAVM 120 W&UUNGUW S!rR JAIL.NAttAcaMIis 01970
To-,9711.74E-9S"•FAx:9711.740.9e6
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: Pli Anon,..A, P Building: 3 0 N
P►Doom,Address:----------- --- R ��--- -- - ____--- -- - -
Properly is located in a;Conservation Area Y/N -1 Historic District Y/N
2.0 OWNERSHIP INFORMATION
2.1 Owner of Land
Name:
Address:
Telephone: p b
3.0 COMPLETE THIS SECTION FOR WORK IN FNZINn BUILDINGS ONLY
Addition kExistti'ng
ng
Renovation Number of Stories vated
Change in Use
Demolition
Approximate year of Area per floor (sf) Renovated
construction or renovation
of existing building New
Brief Description of Proposed Work:
^ n
S
—- — --- �O.-Box-40-M -- -
--- - - ---Mail Permit to: Peabody,
What is the current use of the Building?
Material of Building? If dwelling.how many units?
Win the Building Conform to Law? Asbestos?
Architect's Name
Address and Phone P () Roy 4074 t )
mechanids Name Peabody, MA 01960
978-97 -
Address and Phone
Construction Supervisors License# HIC Registration#
Estimated Cost of Projed i� Permit Fee Calculation
Permit Fee i Estimated Coat X S71S1000 Residential
Estimated Cost X S111S100o Commercial-- ---An Additional $5.00 is added as an
Administrable 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 /4
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