3D HART WAY - BUILDING INSPECTION EI'I`Y-OF��LEb —
/ '-0� PUBLIC PROPERTY
DEPARTMENT
KIM SFALEY ORISCOLL
MAYOR
120 WASHIN¢mN h rREET•"A�MASSACHISLXM 01970
TEL•978-745*95•FAX 97&740-98"
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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:
--- -- -Property-Address:3— �--C—J - - -
Property is located in a:Conservation Area YIN_ W2 Historic District Y/N
2.0 OWNERSHIP INFORMATION
2.1 Owner of Land
Name: iVecl
Address: 3 Nf/2T w4b
Telephone: 97a, -7 - 3-710
3.0 COMPLETE THIS SECTION FOR WORK IN EXISTING BUILDINGS ONLY
Addition Existing
Renovation 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:
The Ch6n'ey Guys
- ---
Mail Permit to: 478 9T7-9400
What is the current use of the Building?
Material of Building? If dwelling, how many units?
Will the Building Conform to Law? Asbestos?
The Chimney Guys
Architect's Name
Address and Phone Pnnhndv MA 01960 ( 1
Mechanic's Name 978-977-9900
Address and Phone
Construction Supervisors License# HIC Registration#
Estimated Cost o Prjed$ aZQ20-- Permit Fee Calculation
Permit Fee $ Estimated Cost X$741000 Residential
Estimate&Cost X$111$100O-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 Z
Date
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