2 PARADISE RD - BUILDING INSPECTION The Commonwcalth of Massachusctts Town of
+ Board of Budding Regulations and Standards ��
Massachusetts State Building Code, 780 CMR. 7'6 edition Budding Dept
i\\ ` kombftva
Building Permit Application To Construct, Repair. Renovate Or Demolish a fk
One- or Tis u-Fwruls•Duelling
This Section For Official Use Only
Budding Permit mber: Date Applied:
Signature:
Building Commissioner/Inspector of Buildings Date
SECTION I: SITE INFORMATION
1.1 Pro outtse `,`\ 1.2 Auesson Map 6 Paml Numbers
L ! !✓ M Number Parcel Number
I.I a Is thishis an acc teal street'?yes no �
IJ Zoning Information: 1.4 Preperty Dimensions:
Zoning District Proposed Use Lot Area Isq fl) Frontage Ifl)
1.5 Building Setbacks(it)
Front Yard Side Yards Rem Yard
Required Provided Required Provided Required Provided
1.6 Water Supply:(M.G.L c.40,1 SI), 1.7 Flood Zone Information: 1.2 Sewage DisposalSystem:
Zone: Ounide Flood Zonal Municipal j9 on its disposal system O
Public i� Private O — Cheek if
SECTION 2: PROPERTY OWNERSH/Pt
2.1 Owner'of Record: 91AW'd1ie
Name(Print Address for Service:
Jo� /0 - 7,%- Y7W
Signmum Telephone
SECTION J: DESCRIPTION OF PROPOSED WORKt(cheek all that apply)
New Construction O Existing Building O Owner-Occupied O Repsirs(s) O 1 Alterstion(s) O Addition O
Demolition O Accessory BldS. O Number of Units Other O Specify:
Brief Desc ion of Proposed Works:
.L 'G
SECTION 4: ESTIMATED CONSTRUCTION COSTS
Estimated Costa: Official Use Only
Item Labor and Materials
I. Building f I. Building Permit Fee: f Indicate how fee is determined:
O Standard City/Town Application Fee
2 Electrical S O Total Project Cost/(Item 6)x multiplier x
) Plumbing S 2. Other Fees: S
a. Mechanical (HVAC) S List: j( )
s Mechanical iFire S Total All Fees: f
pO Su ression
Check No. _Check Amount: Cash Amount:
n Total Project Cost S /� ❑ Paid in Full ❑Outstanding Balance Due
Cp
SECTIONS: CONSTRUCTION SERVICES /3.1 Li/�5/+/�sed Construucctlo/n,Super
/is`o�r(CSL)
d'L/L/L/1(40 `�' (/,4Z&40— Ls.rnw.Number E.prt wn ute
Nyoe of('SL- H9,der /� ✓? List CSL 7 )
/E7 / Type lsce llh luw
Address Type Description
1112* ��'Cl Unrestricted u to is,000 Cit. Ft.
S tn+ n , R Restricted 42 Famil Dwellin
/C CCe[L GL—( ll� N 1 slasorury Only
RC Residential Roolm Covering
Telephone wS Residential Window and Siding
,.—3-� I SF Residential Solid Fuel Burning Appliance Installation
�r� D Residential Demolition
S eg 1 Z C� C%�� tor(HIC) r/�n�55171
HICC y N/it or� HIC Resistrai4NUM Registration lumber
Addms a �� � �40i/` ap�tion Date
signatiuty, _ Telephone c�'" 7141>G
SECTION 6:WORKERS'COMPENSATION INSURANCE AFFIDAVIT(M.G.L.c. ISL/ 2SC(6))
Workers Compensation Insurance affidavit must be completed and submitted with this application. Failure to provide
this affidavit will result in the denial of the Issuance building permit.
Signed Affidavit Attached? Yes.......... 61 NO...........0
SECTION 7a:OWNER AUTHORIZATION TO BE COMPLETED WHEN
OWNER'S AGENT OR CONTRACTOR APPLIES FOR BUILDING PERMIT
I. , as Owner of the subject property hereby
authorize to act on my behalf,in all matters
relative to wo au ri by t is building permit application.rk
o Dale
/ SECTION 7b:,OW�NERt OR AUTHORIZED AGENT DE LARATION
I, �✓OJ�/97 /��uf , as Owner r�Autfthorizcdent rcby declare
that the statements and information on the foregoing application are true and accu my knowledge and
behalf.
Print N
Signature of Owner sor Authorized Agent D
(Started under the poms and penalties ofperjury)
NOTES:
I. An Owner who obtains a building permit to do his/her own work,or an owner who hires an unregistered contractor
(not registered in the Home Improvement Contractor(HIC)Program). will gg have access to the arbitration
program or guaranty fund under M.G.L. c. I42A. Other important information on the HIC Program and
Construction Supervisor Licensing(CSL)can be found in 780 CMR Regulations 110 R6 and I WAS, respectively.
2. When substantial work is planned, provide the information below-
Total floors area(Sq. Ft.) (including garage, finished basement/attics,decks or porch)
Gross living area(Sq. Ft.) Habitable room count
:Number of(replaces Number of bedrooms
Number of bathrooms Number of half.baths
Tvpe ofheating system Number o(deckv porches
T\peof cooling system Enclosed Open
1 'Total Protect Square Footage"may he suhstimted for Total Project Cost'