13 OAK ST - BUILDING INSPECTION I'Ile C'umnlollwe tldt uf''v1assachuselts
J61
Ihhlyd o1 1uilding Regulations and Standards CI'IN OF
\�' "Llssarhusetts Slate Building Code, 780 CNIR SALE.\I
Building Permit r\ppIieation 'ro Construct, Repair. Renuvare Or Denutlish u
(fie-fir ru u•F iunrh' Dil el ll.p
This Section or 0M 'u se Dill
Building Permit Number. D e Applied:
IhulJmg 0111ctaI(Print Nwne) Si tun: /
Dole
SECTION 1: SITE 1 F
I, r erty ress` 1.3 rise s,Slep fi Purcel Numbers
I.la Is this an acre led street? •es no \Inp Nunther Purcel Numher
1.3 Zoning Information: 1.4 Property Dimensions,
Lnniny District lImpusud It Lot Area(s It)
4 Pntntngu(Il)
1.5 BuIldlntSerbacka(R)
Frunt Yard Side lards
Rear Yard
Required Provided Required . Provided
Required Provided
1.6 Witter Supply:IM.G.1.e, 40.§34) 1.7 Flood Zone Information, 1.8 Sewage Disposal System:
MIME� Pris utu 0 zone: ._ Outside Flood Zone?
Check if as Mwieipd( On sib Jispusul s)stem O
2.1 Owner,of R cord, SECTION?: PROPERTY NERSHIPs
N.une(Punt) (u),Stole.l.IP
Nu..tnJ Street rde hunt
F Etnuil AJdrcss
SECTION d, DESCRIPTION OF PROPOSED Wo Ks(check all that apply)
New Construction❑ Existing Building❑ Owner-Occupied (3 Repairs(s) 9 Alteration(s) ❑ Addition
Dentulition .accessory Bldg. ❑ Number of Units
Other ❑ Specify:
Grief Description of Proposed Nark': . y,
SECTION 4t ESTI3I.41ED CONSTRCICTION COSTS
Mein Estin led Costs:
Il.ahur and\laterials) Official Use Only
1. DuilJing S 17,0oo,"" I. Building Permit Fee: S Indicate how tat is determined:
'. Electrical S .500, on ❑Standard City'Tuwn Application Fee
t I'lunihing S Ol�O.p p ❑ Tutal Project C'ost'1 hem 6)x multiplier
_. Other Fees:
J. \Ida li,mieul ill\ \('1 S List:
�upprciiu'nt S lard \II Fces: S
n l'oul Project CnH: S fypU Che.A Vu. _ __(
P.iiJ m Full ❑Outstanding 11.11anee 1) to:
1415- �
[3 OGte
S1:f"I ION 4: f'1)NS1'RI C'!IO,N SF.RV1f'ES
S.1 ' ®C�Zz
cl
s j Iuraiou hateCuns NwnFer
%
NJnte al'l'SL I I„IJet �,._
I ut 01. 111w I•x hclu,s 1.
it IM�rivllAlrl
C is
PC
No. 111J Streel thlrestrideJ 1IhulJiu s li n+ 11,11111)al. IL1
f L+(f l 10 __-- It Itca."ted I t?fiA
P.unil I)eellin
C i 'aa 11,sJ.11e./II' RC R,wlin C'o,crin
µy window and Sii III
' 1\ , gyp//)1t Sp Solid ruul Ilurning Appliances
2'� I �INU N1Fll— I IMAI I millolinn
_ D Dcnloliliun
'I"etc hwte Im;uI:IJJre�i . - � Zt1
Au Rrgistcred Ilu m srw emelll Cunlraelor(111C) / egiatr ruuon Will
Raliun Nti nlmr I`�V
Compun) NJn a o IIIC Itegl,vu it NJntu (,y - M
I:mali aJJNO
N- III Street
A-r- Li N sl role hone
Ci ITown.State ZIP 23C(6))
SECTION 6l WORKERS'COMPENSATION INSURANCE AFFIDAVIT(M.G.I.C. 1l2-
Worken compensation Insurance affidavit must ba completed and submitted with this application. Failure to provide
this affidavit will result in the denial of the Issuance of the building permit.
Signed Affidavit Attached? Yes .......... O
No...........cl
SECTION is: OWNER AUTHORIZATION TO BE COMPLETED WHEN
OWNER'S AGENT ORCONTRACTOR APPLIES F BUILDING PERM1IIT
1, as Owner of the subject property,hereby authorize ��t IJ i U
to act on my behalf,in all matters relative to work authorized by this building permit application. l Zoe Z
Dale
I'nnt Usmcr's Nwne IHlccwn{c Signulum)
SECTION 7b: OWNERt OR AUTHORIZED AGENT DECLARATION
By entering lay name below. I hereby attest under the pains and penalties of perjury that all of the information
understanding.
contained in this application is true and accurate to the best of my knowledge and
Daw
Prim Qencr'i nr:\uthurinJ,\dent'.+Name t rleetrintie Siyn;nura)
No mi
1 (not registered regier\%h iobtamsn the building
ildi g perlilit
d r IcturtHIC) Program), iII 1 f `have a"ess to thearbitrationtbitraitionered ttractur
pmg`ra11 ur guanul iylnfomcu un on he Cunslr oicis.k..Ot er impo tat or enseIntotc-in be found atation on the C Prugra:n c'n be round al
U hen substantial,sork is pl:umeJ, prusiJe the info'tinetluJi g5 helot`,ba. tinisheJ basement anics, Jerks or parclu
`alai tioor area 1 sy. If.l - ---- habitable room eatutt -
irosi lis ing ,11"1 sy. Il.l ._.._ \uulher al bedrooms
\unlher of fireplaces .. _ - \'umber of hall Kuhl
�uniheral'hathrowns \unlherofde.ks, por.hes
I\pe,dhe.ltingi)Hem Open
I`nelo,eJ
I'�pu, l':dohng ;,aein
1 ..I'.n.11 i'f„�ecl \,IlGife i,n,l,l4e MAI he HIhHItl1ICJ IiV..I,d Ji I'tU�eel C',bf'
CITY OF S.ZU.E.t, -AxsSACHUSETTS
BULLDNG DEP1RTNMNT
130 WASHLNGTON STREET, 3' FLOOR
TEL (978) 745-9595
F.ALx(978) 7.10-9846
KI.N[BE.RLF,Y DRISCOLL
ANYOR T}Io%tAs ST.PIERRB
DIRECTOR OF PCHLIC PROPERTY/BCILDL\G CONLMISSIONER
Construction Debris Disposal Affidavit
(required for all demolition and renovation work)
In accordance with the sixth edition of the State Building Code, 780 CMR section 11 I.5
Debris, and the provisions of MGL c 40, S 54;
Building Permit # is issued with the condition that the debris resulting from
this work shall be disposed of in a properly licensed waste disposal facility as defined by MGL c
t 11, S 150A.
The debris will be transported by: "
(��✓17��r) I�AS 7c'
(name of hauler)
The debris will be disposed of in
—... (name of facility)
----(address of facility)
signature of permit applicant
a /zoI z
date -
dvbrisait: lx