4C HART WAY - BUILDING INSPECTION (3) What is the current use of the Building?
Material of 8tibdinq? it dwslWq,how many units?
Will tiw B M*V Confbrm to�a Asbestos?
ArchUdS Name
Peabo
Address ands dy,MA 01960 ; -
MedanWa Name
Address and Phone HIC Regbtratioo 0
Consbudfon Supervisors License 0
Estimated Cost Of Preyed: Permit Fw Calwle w
Permit Fee i 0 - CodX$7/111000 Residential
Estimated Cott X$11lf1000 Corw wcla-- - ..... .
An Additional$5.00 In added as an
Administrative charge.
Make sure Chet all fields are properly and"bly w ttten to avoid delays in praee5111n0.
The undersigned does hereby apply for a Building Perrnit to the above a stated
spwAcagom Signed under penally d PwJurY /`/%
Date ✓C ' e
N
c 1
-- - �- -
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i GiTTUiTScV.E�
PUBLIC PROPERTY
DEPAR"I'1bmNT
,t ,i ,r! i N�rer tv tinr,r r
130 WALUNc.M ftMW*Suw4�rAW1Ue SrTiS 01970
111:MU&Mct FAM V&74."*
APPLICATION FOR THE REPAIR. RENOYA�rfnx_ CONSTRUCTION
DEMOL MON. OR CHANGE OF USZ OR OCCUPA_NCv- ltiO ANY EXISM
STRUCTURE ORB ►n. II�iC• -- FOR
-
1.0 SRE INFORMATION
Laatlon Narrlee
P►openy Addrroas;
Properly Ie bpbd ins;CauNvatlon Area YM Hklorb 01sM YIN
2.0 OWNERSHIP INFORMATION
2.1 Owner of Land
Name:
Add y — 7-
Telep►ane: � v/� f"do
3A COMPLETE THIS SECTION FOR WORK IN MW1BUIUMNGS ONLY
Addition ting
Renovation Number of Stoovated
Change in Use yDemolition tingApproximate year of Area per floor( ovated
construction or renovation
of existing building New
Sdd Description of Proposed
Work-A,/aCe ���o1GCP ,
The Chimney Guys --- -. . --
- - — -Mail Permit to: �.O-. Bur 4074 e - -
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