23C MARION RD - BUILDING INSPECTION 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 The Chimney Guys
P.O. ox ( )
Address and Phone ,
Mechanic's Name - -
Address and Phone
Construction Supervisors License# HIC Registration ii
Estimated Cost of Pr9ject S.L.---
Permit Fee Cftlation
Permit Fee$ Estimated Cost X$71$1000 Residential
Estimated CostX S11/S100o Commerclal�--
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 XL�
Date
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- EITY`QF�LEn Y --
PUBLIC PROPERTY
DEPARnIENT
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MAYOR .:Afj.
17a1 WASMNGn %nPET 4 S•A�'MASSACKSO-5 01970
141:.97.8-745-9S"3i FAi:978-740-9646
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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: 0?3
Property Address—. ---- CRI -- --- - F- - - ---
�.�
Property is located in a;Conservation Area Y/N_[/ Historic DWMd YIN _
2.0 OWNERSHIP INFORMATION
2.1 Owner of Land
Name:
Address: 03 C 2)O v "t✓
Telephone: 7 ('�5 C�p�
3.0 COMPLETE THIS SECTION FOR WORK IN EXISTING BUILDINGS ONLY
Addition Existing
Renovation Number of Stories Renovated
Change in Use New
Demolition Existing
Approximate year of Area per floor(so Renovated
construction or renovation
of existing building New
Brief Description of Proposed Work:
c I �
The Chimney Guys
Mail Permit to: 978-977-9900