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25D MARION RD - BUILDING INSPECTION What is the current use of the Building? Material of Building? K dwelling,how many units? Will the Building Conform to Lay*eXAW= -ny4 Asbestos? X grchited s Name P.O.Box 4074 Peabody,MA U1VbU Address and Phone Mechanids Name Address and Phone Construction Supervisors License# HIC Registration# Estimated Cost o Pro $ PennN Fee Calculation Permit Fee$ Estimated Cost X$7/$1000 Residential Estimated Cost $111$1000 Commercia[ 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 of N � g J y 4 7 4 L _ - �4 - EIT�©FgXrEn -.--- PUBLIC PROPERTY 9� p� DEPARTMEINT ! +r MnroR 130 WASMNamn hMEEr iS.uLy.N/.AtsACHMIis 01970 14i 978-74S-9595'*FAi 978-740.9646 APPLICATION FOR THE REPAIR RENOVATION CONSTRUCTION DEMOLITION. OR CHANGE OF USE OR OCCUPANCY FOR ANY EXISTING STRUCTURE OR BU"MG 1.0 SITE INFORMATION Location Name: Building: o25 10 - - - - - - Property Address.------ --3 b A �C®.✓ ad Property Is located in a;Conservation Area Y/N Al Historic District YIN 2.0 OWNERSHIP INFORMATION 2.1 Owner of Land Name: Address: � s D ./►'11a�l O� 2� Telephone: j 7& —'7 y,5-- T3cPS 3.0 COMPLETE THIS SECTION FOR WORK IN EXISTING BUILDINGS ONLY Addition *ExistingRenovation r/ Number of StoriesChange in Use Demolitionxsting Approximate year of Area per floor (SO Renovated construction or renovation of existing building I New Brief Description of Proposed Work: �1 The Chimney Guvj - — - -- - — - - -- -P.O-Box 40-74 - ------ Mail Permit to: ea o y, - -- -- 77-9900