2 SAVONA ST - BUILDING INSPECTION (3) t4 The Commonwealth of Massachusetts
' Board of Building Regulations and Standards FOR
Massachusetts State'Building Code,7.80 CMR, 7t° edition MUNIU E.
Building Permit Application To Construct,Repair, Renovate Or.Demolish a' ReWsedJa ruary. - "
One=or.Tlvo-Family Dwelling 1, 2008
Section For Off Use
Iding Permit Number Applie
Signature: U�w✓ 0
Building Commss�oner/Inspector of.Buil ' ate
SECTION 1:SITE. ORMATION
I.] Pro erty Address I. Assessors Map &Parcel Numbers
L 1 a Is this as accepted street?yes_ no Map Number Parcel Number.
I.3 Zoning Information• 1.4 Property Dimensions: .
11e
Zoning District Proposed Use. Lot Area(sq R) Frontage(R) -
I.5 Building Setbacks (ft).
Front Yard Side Yards - Rear Yard -
Required Provided Rcqui¢d Provided "-Required Provided
J16 Water Supply: (M_G-L c 40, §54) 1.7,Flood Zone Information:_". 1.8 Sewage Disposal-System: .1-
Zan c Outside Flood Zone?
Public❑' ' Private❑ — Mu¢icipal❑ on site disposal system .❑
' check if
SECTION 2: PROPERTY,PROPFRTY, OVniERSHIP,
2.I Own�`r'of.SRecotn-d: ( I I- �I 1 _
S()Sf V� �4' A%C_ha,�\P -�(�/',V\1✓lS�l rt SG(yk1.2G Sl �\e1M _. p�1 dlCl-�
Name(P t) - _ Address for Service: - - -
-Signature .. Telephone
SECTION 3-DESCk1PTION OF PROPOSED WORke,(¢heuk all that,apply)"'.
t>ev'Ccns4uct ou ❑ 'F is Buiirlin [7 O:;ner-- ?^ ad ❑ Rep31 5(S)� -I'1 ation(s) ❑' Addi6cc C o tt pr
Derh6lition ❑ Accessory Bldg. ❑ 1Jumber of Units Other. $pccif;•:_._tY " :CYiChSS
Grief Description of Proposed Worlc: keot Ct - W -
• n o. S e � e . .
SECTION 4: ESTIMATED CONSTRUCTION COSTS
Estimated Costs:
Item Official Use Only
(Labor and Materials)
1.Building $ �:�i� a l 1. Building Permit Fee:$ Indicate how fee is determined:
2 Electrical g ❑Standard City/Town Application Fee
❑Total Project Cos[ (Item 6)x multiplier x
3.Plumbing $ 2. Other Fees: $
4.Mechanical .CHVAC) $ List
5.Mechanical. (Fire S
suppression) Total All Fees:$.
Check No. Check Amount: Cash Amount
6,Total Project Cost: $.I I. �0tI
t I o7 0 Paid in Full ❑ Outstanding Balance Due:
SECTION 5: CONS TRIIC ON 61RVTC+ES
5-1 Licensed Construction Supervisor(CSL)
JJ'FtrA/t I JP/1!\ lSO 1 - License-Number - EzpiiavonDate. -
Name CSL-Hold
.. tQ(o 4�'h' \� if I SOJZe..S'�S Vtil�i �Moc:3 ListCSL Type(seebelom) 1'S,
Address n _ _ -T'."c tion
- . U . Unrestricted(tip to 35,000 Cu.Ft-)
Sign R Restricted 1&2 Faimij Dwelling .. . . .
�R `3SI-.a�Qy M M Only
RC Residential Roofin Coverin
Tdephone. )( SSd9 - _ WS Residential Wmdow and Sidin : -
SF Residential Solid Fucl Buming Appliance Installation
.. . D .Residential Demolition
t2 L
RegisteredtHome IMPYO ement Contractor(MC) '
CA r .l �n to
RIC CompanyNar�e rHIC ge is pt ame - Re gistration.Number '
Address-
Expiration Date
Telephone .. . .
ss'aa5
SECTION b:WORIMRS' CO&It�PENSAI-tONINSURANCE AFFIDAVIT(M.G L.c 152.-g 35C(6)) .
Workers Compensation Insurance affidavit must be completed and submitted with this application. Failure to provide .this affidavit will result in the denial of the Issuance of the building perpit -
Signed AfftdavitAttachod? Yes :,-.---.. No--.---
SECTIpN 7ac.0�$';SIITHC)I i7"7iTTpN TO$E•CpMPLE.T
OWNER'S AGII?IT flR CONTRA CT1OR APPLIES F OR8I7II� P�1R119T- . .
I,Sd P �t C' ( P en t 1/ 1/l S t as Owner of the subject property hereby
. - authorize .. . r.4y /r n /1i-k1n .. to ad on
my behalf,in all matters
relative to work authorized by this buiildmg permit application.
Signature of Owner . .. Dag -. . .
1
- -?��tlt�l /'L/1 tuSy:zl azi�nbernrAttthotizcd Agetitlreri'bv#eclat_=
hat the=tatcinents and inforniat on en Lhe forceota" appLcation arettuF acid accurafz, to the best of aty i 1e can
behalf.
.Font Name
Signature of Owner or Authorized Agent . Date.(Signed underthe pains and pctialfics of perjury) . .
NOTES:
1- 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(HIGH Progrrnn), will not liave access to the.arbitration
program'or guaranty fund trader M-G-T - c..142A.Other important,information on the HIC Prognam and
Construction Supervisor Lieemsing(CSL)can be found in 7B0`CMR Regulations 110-R6 and 11023,respectively.
2— When substantial work is planned,provide the iuformatinn below:
Total floors area(Sq.Ft.). (including garage, finished basement/attics, decks or pomb)
Gross living area(Sq.Ft-) habitable room count
Number of fireplaces Number ofbtdroorns
Number ofbathrooms Number ofbalflbaths
Type of heating system Number of decks!porches
Type of cooling system Enclosed Open
---- ...
3- "Total Project Square Footage"maybe substituted'for"Total Project Cost ( la o J