8 RAND RD - BUILDING INSPECTION (2) _ � _ _ - -..--- TheC'ommomvealthol'Massachusctts -- _
s 1� Board of Building Regulations and Standards CITY OF
it Massachusetts State Building Code, 780 C NIR S,\Ll \I
/ Building Perinit Application 'ro Construct, Repair, Renovate Or Demolish a
/r !fie-or rivo-Fanti1v Dn elling
VU rhis Section For 01'flcial Use Only
n
Building Permit Number.
� .
g Date ApphcJ:
Building 011icial(Print Mane) Signature ` pale
SECTION 1:SITE INFORMATION
I,1 Pra er,ny Address: 1.2 Assessors flap& Parcel Numbers
I ... IQ co -
I.la Is this an accepted street?yes no Map Numbcr Parcel Number
1.3 Zoning lnliannution: 1.4 Property Dimensions:
Zoning District Proposed Use Lot Area(s4 11) Frontage(11)
1.5 Building Setbacks(R)
Front Yard Side Yards Rear Yard
Re4uired Provided Required Provided Required Provided
1.6 Water Supply:(M.G.I.c. 40,§54) 1.7 Flood Zone Information: 1.8 Sewage Disposal System:
Public❑ Private❑ Zone: _ Outside Flood Zone?Check if es0 Municipal❑ On site disposal spxtcm ❑
SECTION2: PROPERTY OWNERSHIP'
1.1 Ownert of Recar�1
Cl4 �e Al excel,JPr Su/el" MA O/97d
Natnc(Print) City.Slate,ZIP
R r, ! - F&-71/5--L/58Y
No.and Street Telephone Finail Address
SECTION J: DESCRIPTION OF PROPOSED WORK'(check all that apply)
New Construction❑ Existing Building❑ Owner-Occupied ❑ 1 Repairs(s) ❑ 1 Alteration(s) ❑ Addition ❑
Demolition ❑ Accessory Bldg. ❑ 11 Number of Units__
Other ❑ Spccil'y:
Brief Description ofPropo{{edWork--
P Ice x r� W
oew 2e01ncrtm&jk
CtC lLot, z- a
SECTION 4: ESTIMATED CONSTRUCTION COSTS
Item Estimated Costs: Ofliclnl Use Only
I Labor and \Iaterialsl y
i. Building S 5 s�b I. Building Permit Fee: f Indicate how feJdcler determined;
2. I:Ivclrical S ❑Standard CityrTossm Application Fee
❑Total Project Cost'(Item 6)x multiplier — _1. Phunhi°g S ? Other Fees: S
J. Mccha»ic.d III\.\(') S List:.\kchanical IFireSu+ncssion) STotai.\IlFees: S( Check No. Check Aniount: C'.uh \in. Tulin Pn)jccl Crest: S S S7 ❑PniJ in Full ❑Outst:mJing 13al;mcc Doc
V L�
SECTION S. ('0NS'1'RII("PION SF:RVI('1:S
� a �
5.1 Construction Supervisor License(CSL) Q 7��5 �a
E It Do C.✓ i ieenee Numhcr I',pir;uiou Date
Name of(Sl. holder l t
//hh �11..�I"^� ✓ � l isl l'SL kpe(see helowl.__._—_—_—
'1\PI: Description
N o—Ind Slrc t
' r�e� fP n , q d'���7 U Re'tricted 1 Illui mi )s li vi 15,UI)O.u. ILI
('-f I ✓�/I t/7 H Ne.IrietaJ I:C:I'.unil - D,Icllin
Cigl I Iwo, Stole.LIP _ ._—.. . %I �hhun
NC Rlwtin Coverin
._._. µ'S w'indow;md Siding
SF Solid hod Burning Appliances
_ 1 h„nlati„n
1'0c hone Fnmil address D I Demolition
5.2 Registered Home Improve r tent Contractor(H1C) 6 /
pI ��—
n'—P' T'49a g n ee NtauY' l/LIt Ca�G�D I IICItcgistration Numl+er Btlinniun Uatc
IC'Compan) Name or I IIC'Registrant am
fM 54,
No. id nt
lmailaJJnss
(Agior0 M } �x36
Ci /Town,State,ZIP rate hone
SECTION 6:WORKERS'COMPENSATION INSURANCE AFFIDAVIT(M,G.L,e. I52.J ZSC(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 o he building permit.
Signed Affidavit Attached? Yes .......... No...........O
.SECTION 7a:OWNER AUTHORIZATION TO BE COMPLETED WHEN
OWNER'S AGENT OR CONTRACTOR APPLIES FOR BUILDING PERMIT
1, as Owner of the subject property, hereby authorize
to act on my behalf,in all matters relative to work authorized by this building permit application.
Print Owner's Nmne(Electronic Signature) Dale
SECTION 7b:OWNERI OR AUTHORIZED AGENT DECLARATION
By entering Iny none below, I hereby attest under the pains and penalties of perjury that all of the information
cc ined in this application is tru and accurate to the best of my knowledge and understanding.
(d Dow
Print Owncr'i or Authoriicd agent's Nurse I I.Icclronle Slgnauvul Date
NOTES:
I. :\n Owner who obtains a building permit to do his.her own work,or an owner who hires an unregistered contractor
tout registered in the Hume Improvement Cuntractur IHIC) Program).will no have access to the arbitration
program or guaranty fund under NI.G.L.c. Ia]A.Other important information on the HIC Program can be found al
sslso m.l�. n ok.l Information on the Construction Supervisor License can be found at plsl. ul.,.,>:" III,
2. \Then substantial Iwrk is planned, provide the infurnlatiun below:
rota) flour area(sq. ft ) . ____.._I including garage, finished basement attics.decks or porch)
Gross It%ing area Isy. it.) .---- -- _-- - -- Habitable roust count
Nun,bcrof fircl,laees ._. .. _ N'umberofbedrooms
Numhcr tit'bathrooms -- — - _ . . Number ofhalf halts .. . .
1)pool,heating s)slcm Numhcr of decks, porches
f)Ile of Coohn_L' i%Stein - I,IlcloseJ t)I,elt
1. "fatal Pr iv%:t Square Footage" slay he auhstitutcd Iilr ,I'otal Project Coat"