3C HART WAY - BUILDING INSPECTION EI`f'�-BF�XLEi�
PUBLIC PROPERTY
DEPARTMENT
i:l\ DRISCOLL
MAYOR 120 WASHING"h`riiEC "LFJ4 MA1UCil1:ShTIS 01970
TEL 978-745 9%5♦FAW.97&740-9846
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: 3 _ 0 GJ
- -- Property
Property is located in a: Conservation Area Y/N Historic District YM
2.0 OWNERSHIP INFORMATION
2.1 Owner of Land _
Name: G e,-e,4 Do
Address: 3 � I AYz�
Telephone: -7�? 3-7
3.0 COMPLETE THIS SECTION FOR WORK IN EXI&EINra BUILDINGS ONLY
Addition Existing
Renovation c/ Number of Stories Renovated
Change in Use y New
Demolition Existing
Approximate year of Area per floor (sf) Renovated
construction or renovation
of existing building New
Brief Description of Proposed Work:
_33LC Chimney Guys
- P.O.--Boa
- - --- —
Mail Permit to: 478 417700
What is the current use of the Building?
Material of Building? If dwelling, how many units?
Will the Building Conform to Law? Asbestos?
Architect's Name The Chimney Guys
ox �
Address and Phone (
Mechanic's Name 978 977 9900
Address and Phone
Construction Supervisors License# HIC Registration#
Estimated Cost APro'ect$ o Permit Fee Calculation
Permit Fee $ Estimated Cost X$71$1000 Residential
Estimated Cost-X$11/$9000-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 X —
Date a_,_ o�
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