15 SUTTON AVE - BUILDING INSPECTION (2) c
"\ The Commonwealth of Nfissaehusetts
Board of Building Regulations and Standards CfrY OF
Massachusetts State Building Code, 730 CLV[R SALENI
Revised Mar 2011
Building Permit Application To Construct, Repair, Renovate Or Demolish a
One-or Two-Family Dwelling
This SectioaFbrbfficial UsaOnl
Building Permit Number: Date Appl
Building Official(Pant Name) $rgnature
SECTION(:S[TEINFORIVEATION
1.1 Pro pert %ddress: Vt' 1.2 Assessors Map& Parcel Numbers
l� vsL I a Is this an accepted street?yes no Map Number Parcel Number
1.3 Zoning Information: 1.4 Property Dimensions:
Zoning District Proposed Use Lot Area(sq ft) Frontage(it)
1.5 Building Setbacks(ft)
Front Yard Side Yards Rear Yard
Required Provided Required Provided Required Provided
1.6 Water Supply:(M.O.L c.40,§54) 1.7 Flood Zone Information: 1.8 Sewage Disposal System:
Public❑ Private❑ Zona; _ Outside FlooCheck if es if
Zone? Municipal❑ On site disposal system ❑
❑
" SECT[ONZ:; PROPERTlG'01VNERsinEA
2.1 Opn tofRecord: yt�r O(R-7D
Name`(Print) c City,State,ZIP
IS )t. H-6., A-V'C 81 q)o qf5_ )�{�'ialY"iA-f��/�'r"sAn411
No.and Street Telephone _7 Email Adtiress
SECTION 2: DESCRIPTION OF PROPOSED.WOR]e(cbeck all that apply)
New Construction ❑ Existing Building❑ Owner-Occupied ❑ I Repairs(s) ❑ I Alteration(s) ❑ Addition ❑
Dzmolition ❑ Accessory Bldg. ❑ Number of Units_ Other ❑ Specify:
Brief Description of Proposed Work :
SECTION4: ESTIMATED CONSTRUCTION COSTS
Estimated Costs:
Item Of[icial Use Only--,Labor and Materials)
I. Building g L Building Permit Fee:Sj ' Indicate how fee is determined:.
❑Standaid.Citylrown Application Fee.
2. Electrical $ ❑'rotalPrdjectCost)(Item6)xmultiplier x
3. Plumbing i 2. C)ther Faes: S
I. Mechanic;d (IIVAC) 5 List:
i. \(cch:wical (Fire /-
in " "ression) _ 3 fetal All Fees: .S_
Check No. Cluck Amount: _Cash Amount.
n -!'utal I'rnject first: 3 ❑ Paid in Pull 0 Out.standim" iialancc Otw:..___-. __
I.
src,rION5: CoNsrRUCrIONSERVICrS
5.1 Construction Supervisor License(CSL)
Licenst Number Expiration Date
Name of CSL I(older List CSL Type(see below)
Type Description
No. and Street -
U Unrestricted Build"—u l0 3i,000 cu. tt.
R Restricted 1&2 F;unil Dwellin
City/"rown,State,ZIP VI %Iasonr
RC Root-in Coverin
WS Windowondsidin
SF Solid Fuel Burning Appliances
I Insulation
'I'cle hone Email address - D Demolition
5.2 RcgisPereJ Home Improvement Contractor(t1IC)
H1C Registration Number Expiration Date
1IIC Cornpany Name ur HIC Registrant Naane
No.and Street Email address
City/Town,Sate, ZIP Tele hone
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 provide
this affidavit will result in the denial of the Issuance of the building permit.
Signed Affidavit Attached? Yes ..........❑ No...........❑
SECTION 7a: OWNER AUTHORIZATION TO DE COMPLETED WHEN
OWNER'S AGENT OR CONTRACTOR APPLIES FOR BUILDING PERIVIIT
I, as Owner bject property,hereby authorize
to a on�my behalf, n all matters relative to work authorized by this building permit application.
Print Owner's i e(Electronic Signature) - Date
SECTION 7b: OWNER' OR AUTHORIZED DECLARATION
By entering my name below, I hereby attest under the pains and penalties of perjury that all of the information
contained in this application is true and accurate to the best of my knowledge and understanding.
Print t)wnerl or Authurimd:\;ent's Name(Electronic Signature) Date
N07ES:
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 mat have access to the:arbitration
program or guaranty rind under M.G.L. e. 142A. other important information on the MC Program can be found at
www m;a5s.�uv/tree Information on the Construction Supervisor License can be found at aww.mas ..nye_dL
3 When substantial work is planned,provide the information below:
Total floor area(sq. R.) _(including garage, finished basement/attics,decks or porch)
t?ro;s living area(sy. (t.) fl:abitable room count —
Nnntber of tircplaces_,-------— Number of bedrooms --------_--_—.-_----
Vuwbenafbathmuitts Numberafhaltibaths ___"_
1'cpe of he.uing;y,tant Number of deck„ponhcs -__._ _---- _—__--
I' peof,cooliny ;y<lcnt Enclosed Open
4. "I'n�al I'n.q:,a Syu.ire Pnot.u(e" w.ty he ;ub;tinurd t;,r mject
CITY OF S.U-E.tif
PUBLIC PROPERTY
DEPARTMENT
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HOMEOWNER LICLNSL EXY.tiWTIO►V
Pion" Prime
Due
lob Loeadce
Home Owner Address
Home OwMW Telephone ----
Present Mailing Address
The current exanpdon of"Homeowner"was extended to include owner-occupied
dwellings of two Units or fees and to allow+such homeowners to CUPIN as individual for
hit@ who.does not possess It Ilebswr,provided that the owner acts ae supervisarr
DEFINITION Ol HOMEOWNER
Perwo(s) who owns a paned of land on which hdshe resales or Intends to rewde, an
which then ire, or is intended to bet,a ane or two &mihy dweWn& M ehed or detached
strtrcttw" accessory to such use and/or 13rm sgrsctut@u A person who constructs more
than one home in a two year period shall not be considered a homeowner. Such
"homeowner"shall submit to the Building OQfeiak one a forma acceptable to the Building
Permit that helshe be responsible for all such wort performed under the Building
The undersigned "hameowndr assumes responsibility for compliance with the State
Building Code and other applicable by-laws and regulations.
The undersigned "homeowner certifies that he/she undentands the City of Sslem
Building Ceputrnent minimum inspection procedures and requirements and that hdshs
vill comply with said Procedures it
HOMEOWNERS SIGVATLRB
\PPROVAL OF BUILDING O;SPECTOR
See other We for state code
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