Loading...
18 NAPLES RD - BUILDING INSPECTION (2) . ,� . � � ��� o � CK � 9-71� r,n� f � I � - �, - _ � -- I he Cununomvr;ihh ul M:usarhuuus ('i'I'1' UF � r, ,y� IluurJ oF11uilJing Krbul:iti�ms anJ SGmdards + ''"� ��1;issarliusctts Statc �uilJing CuJ�, 790 CM1IR S,\Ll?�\I 1' �:� 'ti�,.. Rr risrJ.I Gu•'�II I 13uilJing P�rmit r\ppiic;lhOtl PO CUI15IfUCl. RCP�IL RCtlOV;IIt' O� DCIIlUI15I1 � (biv-ur T�ru-flioii/1' Uir,�/liu.e 1 his Sectiun For Otlicial Ux Onl l3uilJing Permit Numbcr. ta� pplicd: ' -- �,,,p ' 3 ,�o/ . UuFlJing Ullicial�Prim N;unc) SiµnaW �)��� ` SECTION I; SITE INFORIIIJITION I.1 Property.1JJrae: 1.2 ,1�ae�eure btwp& Purcel Numben f��ll��' I�Q I.la It�Ihis an:icce tad slreet? •ef no ��+�P N������� I'urcel Numlkr I.J ZonlnQ Infonnutlon: 1.� Property Dimen�lon�: Znning Diytricl I'ropo.aJ Usc Lul Arcu(sy 111 I�ronluga�11) 1.3 BuIIdInQ Setbacka�R) !'runt Y;vd SiJc Yunls Rcar YarJ Reyuired I'roviJed Reyuircd Pruvid.d Nayuircd I�NYItIC1I 1.61V�ter Supply:�M.G.I.c. JU,§ia) 1.7 Flood Zone Informallon: 1.8 Sew�Qa Dl�po�al System: I'ub�ic O Pri��um O Znna: _ Uu�ide Fiood'Lune? Municip�l O On site Jiepusul a�xtem � Check if �ce0 SECTION2: PROPERTYOWNERSHIP� I,I,�Ojwner�ofRego�rd: � t17h'trvs �'.+��w-�-c /�'�a , N;unc!Prinq (uy.Smta l.IP !� f'�Fy�G ft � � 7d/-63r-IGs�3 Nu.anJ S�na� f.lrphune Emuil AJdmes SECTION J: DESCRIPTION OF PROPOSED WORK'(check oll that opply) New Construction❑ Existing Building O Owner-Occupied ❑ Repairs��) O Alteratlon�s) ❑ Addiiion ❑ Denwlition O Accassory Bldg. O i er of Unin ther O Spuci� , Drief Description of Praposad 1Vork': j / Liq/� •� SECTION �; kSTIJI.�TED CONSTRUCTION COSTS ��`��� Esiimaied Costs: Offlclul Use O�I ILabu�nnd.\latrrial�l Y I. OuilJing S �j pZ� Lc, I. Building permit Fee: f Indicate how ke is detrrntineJ: i '. !il¢cuical S O Standud Ciry�Tw�n Applica�ion Fee ❑TutN Project Cost�I liem 6)x multiplier _.._ x � � 1. I'lumhing 5 ,. U�her Faas: S — - ...-- - � 1. \I.:h.mical ill\'.\CI $ List: 5. \lah,�niral ifirc - '- ----- ------- -- . _ ------- -- --- -- -- .......__ � 1u��rcsiiUnl S Tat;�l .\IIFCCS: S ChccA \b. (�hcck:\mi�unt l',uh �\ni�ninl: ; o Tutrl Prnject Cn.�t i 23p� • tc� ❑p:iiJ in Full ❑llwst;mJing li.�l:mc¢ Duc: I r , , St:("IION S: l'1)NS'I'RI�C'flf)N tiF'RVI('F.S C.t Construc�iun Supervisor I.ic¢iue 105L1 �(�9��_ _ �'� l3 . .l_`L_�c �£�Z . ..._--- I ic.ns¢Nunihcr -- ._.- I����tlian I):il� �,"�''----��`-'� _ ..__ __ .._.. � / ' N:uncu(C.11. Iluldct (/ � I i..l C\I. I'��x I;.c hclu��l.'_"—'.'-_—'_ - -�r7 �laU�7� D1/ � ----'-----------'--��---- -'-.-.-'.----- �I\pu Dc>cripliun Nu. md Strr.l � ,_ / l� 1�nrestricicJ I IfuilJin�s u w iS.11110 ca II.1 �[�.-�/✓l� .._._--"—.. . . R Na.�uic1.J I.r? famil � D�wllin Ciqifa��n..41;n¢.LII' .�i \loiuu � ,,�^ RC N�sdin C����crin � l�' '' /� ' D / 4 � � �1'ti K'indo�r.mJ tiiJin � �. . ...—. SF tiuliJ fu¢I Duming A(IPII�IICC9 1 � � � IIISIIIJ11110 ' �Ibic hunc h:m;iil addrexa D Dcmoliliun �.2 r�letereJ Ilume Impruvrmrnt Cuntrnclor(HIC) fU�GQ 7 3 �L ("'�c4 � �c9 J G�-�GZ-' IIIC'Rcgiatraiiun Numlwr I.cpmili�m Uul¢ I IIC�j'nnp�n� Name ur I I� ' •gi�an��ne���C u/ /3�[�L Nu. wis►.5.� �!� ��-� ` 'j'�-g j2 - ��C((/ I:IIIJII��II�R:19 c7 � �QS� Pi C -CCrw�'0 ` ci rroWn. s�,ce ZIP T�I� hune SECTION 6:WORK6RS'COMPENSaTION INSURANCE AFFIDAVIT(M.G.I.e. IS7.� 2SC(6)) Worken Compensallon Insurance affidavit musl be completed and submitted with thi�application. Failure to proviJe thi� afTidavit will result in the denial of the Is�uance of�he building permit. Signed Allidavit Attachedl Ye� .......... O No........... SECTIOIV 7�:O�VNER AUTHORIZATION TO BE C011IPLETED 1VHEIV OWNER'S ACEIVT OR CONTRACTOR APPLIES FOR BUILDING PEltMIT I,a�Owner of the subject property,hereby authorize to act on my behalf,in ell mntten relative lo work authorized by this building permil application. I'nnl Uanar'e Nwne(Elccuunic SignUwrc� DUIC SECTIOIV 7b:OWNER� OR AUTtIORIZED ACENT DECLaRAT10N By entering my name balow, I hereby attest under�he pain�und penaltie�of perjury Ihat all uYthe infurma�iun conlained in thie opplic�tion is true�nd accurate to the bast of my knowledge and understanding. 1'rinl U��nur'i nr:\ulhiirircJ,�gont'+`1;unu I l:leclrunic.`iyn;iluru) ��t� �o rEs: I. .�n O��ner ��hu obtains �building pannit to do his.har uwn wurk,ur an awner��ho hire�an wv¢gisterrd cuntr�cwr �nut registarcd in ihe Huine Improvemtnt Cuntracwr IHICI Program),��ill no have uass to the arbiuoiiun progrmn ur guaramy I'und wider\I.G.I.. c. 11_'.a. U�her impunaN inform�tion on �he HIC Progrem ran be thunJ u ������ n�.r.. ��� ��..i Inform:uiun un �he Cunstruction Supervisor Licrnse cnn be faund a� ������ ������ >:�� ��P� _' ��'han subsianlial��ork is pianncJ,pro�iJe ihc inl'unn�tiun bclow: I'o�al fluur arca Isy. R.1 _ ----..-1 including gurogt, tinished b�sement attics.Jaks ur purchl Gruss li�ing arca i sy. ll.� __._ _ Habii:ible roum cuunt __, _... . _ . � \umh¢r uF lirepl�ces ... \umbcr al heJruums . _ .. .. .. . . \umheraibadvaumi -- ._. . . .. — �'wnbcrul'h;ill'hoths . . . I I'�p.ol'h.,�ting s�si.m . . . - . . \umhcr��I d..ki, p��r.hes � i � � I\pu��1 i�N�ling i)rltnl I�nCI��iCJ ._(l��.n � 1. "I��q,d I'mj«� ti��u;vC I�naldy'C��m;q h¢:uh,unitcJ Ilv"f��i;d Pruj..i Cusi" � i r« ;:�,���� � C['I'YUPS.�LE.�,t, �L1S5:1CH[;SE"ITS ,;. � 1' UL'uni�c Dea.�K'r>te.�T ����') '�'� �': ''(;� � I�O \YJ.�3NL�IGTOY STREfiT, S1D FLOUR :����.. ��:,.� I�L (978) 7�5-9595 - F.��c(979} 7 i0-98�16 !��(B�Y DRISCOLL � �L�YOR TEiOtUSST.P1E.iA8 DIAECCQRUF PCBLIC PR�PEATY/OCII.DNG CO\L�IISSlU�ER Wnrk��r�' Cumpensallon fn�urance ,�tTiJ•rvit: l3uiidcrs/Cuntr�ctorvlElectrician�/Plumber� \iiplic:int In(nrmuNnn PlcaYe Print Le iblv .V;IiT10ll1miik,�Urganuaii�imlmlividua��:�f �L.�i'L ��� ✓Ci�C ✓L� :\�dress: f 2 �L•,✓ �� ✓L '� JG� CityrStatc/Zip: JKJ-� �..�� '�� PhuneN: S�� ' `�'i � Z S � �� ,1rc ynu�q cmployer!Cheek ths eppropriate bais 'fyp�uf pmJeet(requl�ed): L Q I am a employnr wi�h i. Q l;un a genural eun�ncior anJ I 6, �Nua eonyuvc�ion 2.� mploycra(fLll anJ/or pan-tima).• hava hircd�ha subcoNnctan I am a eole proprimar ur p;utn�r• lis�nd on ihe�tnchcd nhect � r• ❑��madtling >hip und have nu empluyeea Thes�subcoNmcton hsvo 8. ❑Dentolition aorkfng ti>�ma in:u�y capacity. workaq'comp.ineurnnea. 9. �Duilding�dJitiun (Vo wurkon:eomp.inauranee s• O 'HQ�m a cornamdon anJ iu requinJ.J orflcen hove azercieed their �Q•�Electtical ropain or addi[iona ).0 1�m a homcuwnur duin�all wark riyht u/exampiiun per MCL �LQ Plum6ing rcpuin or uddiNom my3el(.(\o work¢n'cump. c. 172, �1(41.and wa hnve no 12.Q Raof mpain insur�nca reyuireJ.� � �mpluyeaa.�No waher�' � cump insurunca myuimJ.� U,[]Olher �.��iy upptl.:uH iluw.�h��t�6oa�I m�u�alru fitl uul ih�uciiw h�tow+hawiny i�air vpk�d mm�rnmlun pW(ay inM1umudoa �i A.neuwm.�n wAu.uBmi�ihl��Melovi�ind�eainy ihry an,loiny ull w.�h nnd ihrn him uuitiJ�eanineipf m�u�nihmi/�naw aittJavil indiainy�uch �f'��nin.wn tlwl cAa<k�Ai�bux mwl�iucAul+n.WJitlurvJ.h�al.huwiny rtw mm�v a(rAa�ubauntrulw�mJ iAalr wnrMen'wmp.qdlry Infarnuflan. . /u�e vn anpluy�r rhutls pruvldla,�ivorkrn'eumpruradun Guurunc��a�iny emp(uyrrt Be/uw b du poliry und Jub str� � injunnurinn. In.�ur�nce<:umpany Vame: __...._. Pnlicy 4 or Self•ina. Liu. d: __ Eapiratian Dale: ' lub Si�a AdJrcxy: CitylSretr/Zip; �it�ch a cupy u(lhr norken' .ampon»tlao puller declaratlan p�K�(�howlnQ th�poller num6ar and�xpintloe dam� F'.iiluru iu sueuru cuvernga ax rcquired unJa�Section 21,\oP�(GL a U2 can lead to ihe iropmi�ion of criminal penaltiaa of a rir.0 up ro i I,SoU.UO unJ/ur one•yau impri.�onmcnt,��wcll�y civil pcn�itia�in thn fomt ul a STOP WURK UROEA anJ a lina or up�o S_'i0.�10 �Jay iyainst rhe violaenr. Ile�dvl;ed�hat�cupy ui ihiy..��temem mry bu tunv�rJcd to ihe OI'iiea of Inrr,iig�iiun.r ni ihr n1.1 I��r intunnce coverage v.riiir�tiun. !�/u/r�rrby cn�i uuJ�� m�J p �/rlr.r�i/p�ijury rhur rlre injunnudm�pruviJeJ�Guvr ir aut�a�J ro�rrat -, " , u:�ra: 3 �o %L rr..u;c,�: � . U//icru!n.�e��uly. /l,i uo!�vriri rn dn:r��r�i. ro h�cunrpl�I¢J by riry ui 2w�n n��1ei�L (:fry,�r�l'�n.n:_ -- - -- PermiriLkcnfe 9 I.�ui�ip,.\ulhorily (cirCla unu): —._. .. . -..._ . . ... � I. lto:�N ul Ilc�l�h !. Ouildfn� Ucpariineu� 1. i�l�y/f'ui.n Clork l. (ilrctrit,�l fn.pcctnr i. Plumhin4 (u�p,ttar 4. I)Iiiet --_' _--._. .. j Cu�il.i•1 I'tnnn: ._____ ___' . .__._._ Phnnc.h : . .'� CiTY OF S.l[.E.�[, �tiL1SS.ICH(.'SETI'S k3ClLOLVG DEP.1ATtF.VT I _'0 �p.l3HGVGT�N ST7188T, 1'�Ftapll I1�2. �97� 7�S-9S9S !u�csEAtSY ousCocL P.uc(9��J►498�d .tiUYOII MO.Wf SL P[F11s DIRSLTOR OP PCBLiC PRaPlR7Y/BCQ.DNG CO\t�lIS3IONE11 Constructlon Debrl� Df�posal At'fIdavlt (required for sll demolidun and renavation work) ►n ueordance with ths�ixth editton otthe State Building Cade. 190 CMR section I l 1.3 Oebri�, and ths provioiona of�btCL a 40, 9 J4; 0uilding Pertnit A1 ia is�ued with the condlttan that the dcbria re�ultinq from ihia wurk �hell be diaposed of in a property licea�cd wmts dl�poaal faciliry aa dcRncd by,�ICL c 1 I 1, S 1 JOA. The debri� will be trnn�portcd by: � c�c' �,c���-�— (n,una uFAaular) The Jebri� wi II be dispoeed of in : �u�s� C�',�.� (nam�of facdily) ,�� SG � - ��L�� (�Jdrea oYf�c�hry) u�n�mre ufpermit ipphc�nt � � � ,:��a , , .�i � . - - . . i " � o.�, _ -� �-r�-z� � -75��� /� 7}' , � � � C� �,s����r 'ld �,�,� u��'105" � ' • . � �O i Y r�..,v�-LI �S�'.� aZ S��d,vrl 8 / „��� 55�y Sn!�TI l� -�-v� � �' �� � I j �— h� p� �y --��-- ------- ----- ______ —_ O Qz ---- - --------- � � " � I ciN no7�9 ,� — - _ _ _ �..,..,.- _ ._ ..— �-- ------ �-----_ _____ __ __- - - _. ___ .___.. e- - - _- - � � �...:�,. � � � .-.=,.�-. -ys,.. _- ,;�-> - _,�- „-w--- �, „ 7 � � ' i -�---I _.__--------------" _ . -- ' i: � � _I �_. _ _ _______.� � Z � � ; ----- ----.._ ____.__-- ( � -- - - ' ; - � , , , ___--------- � --- ------..._T---_----- - I - ; __---------;I---- ______ _ .._ __._. --�— ---_______--_ _ ! ' � ---- ;------ � ; ; ----- I , _.___.__ ----- ___...____ --- � I � _! __ ., . . _�,. __-_-���-- � - --- ___ , __ ___ „� � _�.____--- � _ � � � � � _-�- ----------_4 _-- , , , , -- I I ' I I � ---�-==--.W-_�v..�__ -----""..__---- � � , ,, - � ; , � -------- - i ; I ___-_ ' ------ -�-------- , ;. � - -- __�c_— --1------ _ _ --__--. - - -- - i � J J ; , � : I �: � jli I ! I I , I � � � I i � _._ i ----- - --_. - -. . � - - I -- -- - - - - --- __ , _ - - - _ . _ __ .. _ � --- --- ---- ..__. { _: ; ___ . _ _.. ----_. __..__ . , , - ------- — i � � , ' I ;-- --- -�------- -- -- -- ,-- ---_ � ---_ � I ' ;, _ _ .__ _ —�=_-_� _----___ � �...—�_.�_____.��.� i ' ,a : ; � � I { i i � � ; a � I ; I � ; � � ? ' I � � I _ _ ! � ; ' i i =--------_�.. . . ---�.---�-- . - - --. . ._ ._ - j __. _ _ ..�_ .__ _ . ---- . � --- J'- i ------ I � I � . _. _._._ �, i _ _-- -- . - ---, � ' � ,8 � , I ; ; � � � ; I , ' _ , , � --- -- --- --- -- --- ---- -- --- � -- - - - r -_-- _, ---- - - - - ---_ _- - _ _ . _ _ _ _ __ ___ _ _._ _ i _ ., � x� � � _ � I � I Q�g Za� �7� � I i — r,--- -- , , � �-- I ------ � ' � - - , ,,.. _ .- - .. . .,,. _ _. . ._ __ _. _�.. .. . _. . _ _._ --- --- -._ _ _ �_. _. _____--- -----1-:--- Z Q Q� � _ _ _----- -- \�� _ . � s nn�--I � �,