15 PARALLEL ST - BUILDING INSPECTION The Commomcealth of Ma.asa¢husCIIS ---
t` Board of Building Regulations and Standards F( IIt
i Massuchusens Scale Building Code. 7S(1 ('MR, 7"' edition
Building Permit Application To Consu art. Repair. RCIIOs ate Or Ih•nxtlisll a Krl nr,l huuer 1
UnP- ol Tit o4lonilvDtr<dlin,A1
--i
This Section For Official Use Only �
Buildingwgc'
Date Appliedy."___-----
/, Q
Slen,lural7 In>preRu of BwlJmgs U.ur
SECTION 1: Sl FE INFORMA FION
L I_Pro rrN .\d,r7/1irrss:C� 1.2 Assessors Niap S. Purcel .Numbers ---_--
— \I;— s;.:ether Parrrl Nunlhrr
i.la 1. dtio u, a.ieptCJ SnrcCl' `;Cs� nu P
_ —
I,;i l.J Pn;rrrt+ Dtm,•nsiuns: i
t,;
1.5 Ulu iiding Se!backs tftl _
jr Side Yards Rear Y`..iid
Front Yard
it Pn.vaed Requited Prn.;ded RrL•w;ed Pn���uca
Rayuired y _ ( "___ --
_—
1.6 Water Supply: (M.O.L c. 40. §54) 1.7 Flood Zone information: 1.8 Sewage Disposal System:
Public ❑ Private ❑ Check if yes❑Zone: Outside Flood Zone? MamaP I al ❑ On,uC dis>tlsul s 7 elcln ❑
SECTION 2: PROPERTY OWNERSHIP'
21 Oy��lerr of Record-,
�C fF{ie4) /YIPr�/ /� �wra/k/ s7-
N.ur.:: _0 Intl Address lire Se re lee:
&*iJ 71m -73
Slglr,turn Telephone
SECTION 3: DESCRIPTION OF PROPOSED WORK'(check all that apply)
!New Construction ❑ Existing Building ❑ Owner-Occupied ❑ Rtpaosis) ❑ Alteration(s) ❑ \JJiiiim
— ---
Demolition ❑ Accessory Bldg. ❑ I Number of Units_ Other ❑ Speuly:
Brief Descr,},uun of Pro
po
ased Work-:�i eL /O) Xa41 deck Orr s,?d2 Of he'"P &✓rLti —_
8' lKcriF o✓er 'o bcc-!c dear odic s r ---
SECTION 4: ESTIMATED CONSTRUCTION COSTS
Estimated Cults Item f Labor and Materialst Official Use Only
1. Building S I. Building Permit Fee: S Indicate how fee Is Jelennmcd:
❑ Slandard City/Town Application Fee
2. Electrical S ❑Total Project Cost (Item 6) x multiplier x _
i. Plumbing S �. Other Fees: S
4. Mechanical IH%'A0 $ List: _
5. Mechanical (Fire S ---
Suppression)
rural All Fees: S
Check No. Check Arn,unr _ (',I,h :\nu L1111
0 rotal Project Cost S Jt ��) 0 Paid In Full 0 Outstundmg Balance Doc -__- __
r
SECTION 5: CONSTRUCTION SERVICES
5.1 Licensed Cunstruction Supervisor(C'SI.)
Llccn,c Number F\pu:atoll D.ae
N al tie of CSL- IluWer
LI,I CSL 7\pc rsee hellm
� \ddres> I v c Dc,rrl �Uun
L Lltrc,lrlcled u) IU ".W0 01. Ft
--- — R Re,tncled L@_' F.Ilnlls DIN:Hlo_e
Sl nauua %I Masonn (
RC Rc,IJential Rooline
felcphune \\S Re'ldrnt lal \\ nduo .oid Slihn_
SF Re,ldcnllal Solid Fuel Buuun_ \ >>h.ul. hl.l.ilLwm
D Re.IJ:nual Will"1ltion
5.2 Registered Home Improvement Contractor(HIC) —
IiIC Company Nautc or 1-11C Reelstranl Name Registration .Number
Address
F.npl ration Date
Signature Telephone
SECTION 6: WORKERS' COMPENSATION INSURANCE AFFIDAVIT(M.G.L. c. 152. § 25C(6))
Workers Compensation Insurance affidavit must be completed and submitted with this application. Failure to prosldc
this affidavit will result in the denial of the Issuance of the building permit.
Signed Affidavit Attached? Yes .......... ❑ No __-. ❑
SECTION 7a: OWNER AUTHORIZATION TO BE COMPLETED WHEN
OWNER'S AGENT OR CONTRACTOR APPLIES FOR BUILDING PERMIT
1 as Owner of the subject property hercbv
authorize u) act on my behalf, in all matters
I
relative to %")Ik authorized by this building permit application. j
I
I
Slenalure ul Owner Date
SECTION 7b: OWNEW OR AUTHORIZED AGENT DECLARATION
t , as Owner or Authorized Agent hereby declare
that the statements and information on the foregoing application are true and accurate, to (he best of my knowledge and
behalf.
k(Slgi"ned
Name
ure of Owner or Authorized :Agent Dale _
under the sins and enalties ul' egu )
NOTES:
nOwner who obtains a building permit to du his/her own work, or ;mowner who hires do Lim egl,(ered annra,for
ut registered in the Home Improvement Contractor (HIC) Program), will nut have access to me ;u'bitranon
program or guaranty fund under M.G.L. c. 142A. Other important information on the HIC' Program and
Construction Supervisor Licensing (CSL) can be found in 780(.'MR Regulations I I0.R6 :md 1 10 R5. respects
When subs(amlal work is planned, provide the information below:
Total flours area(Sq. Ft.l
Imcluding garage. finished basement/aBlcs, decks or porch,
Gross living area ISq. Ft.) Habitable room count
:Numberof weplaces Numberof hednenn, __--_--- _--
I Numberot hathroums Number of hAtib,uh, --"-,__ --
I\'pe of healing ,y,tem _. — Number of decks/ p,gihc,
Type oI cooling Sy,lem "-
J. "Total Project Square Footage" may he ,ubstl(ued for furl, Protect ( u,l" _ JI