7 ORCHARD ST - BUILDING INSPECTION -oc--
The Commonwealth`of ...45.40m
z F ......
tundurds
ti. 0
7m ......-
I
UJE
.1 icd
.....Fitr _yDnellrnam:
15A
SECTION,1, SITE,NFO MATFORQtM.�'.,�
..............................
taj
UM �
o,
111".f .�t ll.lt
1.4 Property
IrN
Fliibd, 11 Sew 6 Sgstem
"Ici
..........
"-Ty,
z SECTION 3:,+DESCRIPTI,ON OF ito
Jt.....
dth
I)e no wow ::
Brief Description dfpropo. c Proposed Work
4K
SECTION 4 ESTIMATED CONSTRUCTION COSTS L � '�
Estimated CDsts
Irern (Labor and Matenals)
r
om
�c 2
LLthidl6i how fee is determined'*
b6iList
zp�.
AC)
amp,
L,jt ,r Check No Check Amount Crsh AmiwnL
6 Total Project Cost 1 _, p Pord,in Full =' ON
5 M ,,_,,;;
C_
ys k i k 45ECTION 5CONSTRUGTION SERVICES VAik
;: 51}+Licensed Constnictloo,Su ervlsor( 'f.SL) � mns
G ,t <i f"i1,x `..
3fi�+` } , r- ,- h , Li�enie,Number } Expuution Dnti t +i , ct
, r t t �
x'•t Nrmc ofGSL HUlder4� ,f f n i f'r , � - ' ' r -- " z� 4
� ':_+ �T (t. 5 = 4 T �.kt y. �� i--ro.:Descn nef1.:-•� fl t "r-r ri -
' - allA U� r Unrestrirled 1- to3S 000 Cu FGI - ;_ +
m
05 :Resfnc(al=1&1 F tyiDNtlbn : s s t '., Nz
r r i
'�Resitleoliul,R«ifin�tCuvcnn ' ,
a Telephone- _ :: y ,.,, _ F
� 1YS�:r Restilchtiul Wmduiv�und Sidin
+ " r SF. R�sideriiiul Sulid Fucl Bumm 1 IIJnIL"ifsW1 W nP
r '
3 2'RegLs eee�Home Imp o wont Contractor
1 .HIGCompanyNameorHlC.Regi trust Name
r : Regis n Number `
5
Aj_j melon Date
' Stgnoture - Telephone'io
' � `; SECTION 6"VVORICER$'COMPENSATION'INSURANCE'AFFIDAVIT(hf G L.c 1§2:$'2SC(tn),+ � -.
'` `; ° :Workers Compensnuon insainnce affidn3n must be completed and;submitted with this applicunon Failure to'pnwde -
, tills uffldavit wili`reault in the deni¢I of the lss`nance of the budding permit �'
r} Signed;Affidavlf'Attached7��t�,"Xes � tom" r`, Natr t O '' f � s " ,
�� �' ' ti r °SECTION�7a OWNERtAUTHORIZATION OBE COMPLETED WHEN' c � <t t Y i
:� Lr 'OWNER'S`A"GENT.OR`CONTItACTORAPPLriE.SFOA�BU1L�DaVGPERM17r' - Y �
£
as Owner of the subject property hereby
--Sy
authonze '� aB[o ton my:behhif m allmcuers _
5re1¢nve to: ` rk au byth)s bulldm" - rmi[applicetion ' -- ^' S
' , Ft,4 c { SECTION�b OWNERt OR AUTHORIZED AGENT DECLARATION` ' T r ,
I � ,!�'�"'� ' ¢s Owner or Authorized Agent hereby declare �'`
that the statemnnts and mformatioa a the foregoing application are true and nccumte to'the best of my knowledge and
.,:.
nt eme'd � r
s =Signanite'of O or`Rutho em ' 'y. w ; -�Oa[e r ' _
ti
1 An Omer who obtains n building permtt to do his/her own work or¢n owner who hires an unregistered contractor
�- :�y (not+registered in the Hoiu Improvement Contreiitor(HIC)Progrem) will Z hnve atxess to the urbrtmnnn : i
5 :'.,..fpragmrn ar guai¢nty�fuml,unifer M O I3.c 142A Otherimptirmnt information on the,HlC Program and � '
* ,' -��Coirstructmn Supervisor Iskcensmg(CSL).can lK found in 780rCMR'Re`gWudons 110 R6 wtd 1 LO RS respectively
When:aubsmnnal work is pIarteed provide the in nun below�; + •, r "� -::k`t
,Torsi floor's urea(S`q`FL) �� ' �-pncluding`gnmge,finished basement/atbcs duke ur pon:h)
x Gross Rving niea(Sq iFt) v .Habitable room cwiint•
lYumbv of}firepinces Number of bedrooms . : h
Numtieraf6athrooms` ` Numherufhalflbaths
Type of heeling system ` '' Number ofdecks/porihes
Type ofcoolmg system_ Enclosed Open2q,r k _
3 Total Project Sgonre Fooiage-trmy W subshttucd for 'TotdI ProieM Cast
i
.. .. . .... .. .. .. . .. . . v .. .... ,...