21D MARION RD - BUILDING INSPECTION (2) PUBLIC PROPERTY
DEPARTMENT
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APPLICATION FOR THE REPAIR. RENOVATION CONSTRUCTION
DEMOLITION. OR CHANGE OF USE OR OCCUPANCY FOR ANY EXISTINGI
STRUCTURE OR BUILDM .
1.0 SITE INFORMATION
Location Name: J Building:
-- -- _ Property Address --- --_
Property Is located In a.Conservation Ares YM Historic Dh*k t YM
2.0 OWNERSHIP INFORMATION
2.1 Owner of Land `
Name: Zr ; c T/ ck—
Address: �
Telephone: 9 O c-
3.0 COMPLETE THIS SECTION FOR WORK IN E U3nNG BUILDINGS ONLY
Addition Existing
Renovation Number of Stories Renovated
Change in Use New.
Demolition Existing
Approximate year of Area per floor (sf) Renovated
construction or renovation
of existing building New
Bdef Description of Proposed Work:
The Chimney Guys
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---- ---Mail Pennit to: 978-977-9900 - -
What is the current use of the Building?
Material of Building? if dwelling.how many unitsT�—
Witl the Building Conform to Law? Asbestos?
The Chimney Guys
Architeas Name ox
Address and Phone--rcabef}��ri1 n�960 ( 1
Mechanies Name - 77-9900
Address and Phone
Conebuction Supervisors License 0 HIC Registration S
Estimated Cost of Project i6� Permit Fee Caksulatton
Permit Fee f Estimated Cost X$7/$1000 Residential
Estimated Cost X$11/$10W Canmercial'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 bui the above stated
specifications. Signed under penalty of perjury /� ✓///
Date S
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