The URL can be used to link to this page

17 SUTTON AVE - BUILDING INSPECTION The Commonwealth of Massachusetts FOR i Board of Building Regulations and Standards iNUNICIP.U.ITY I .! Massachusetts State Buildi» Code. 780 CMR. 7"'edition g USE �4't.yt Building Permit Application To Construct. Repair, Renovate Or Demolish a Rrrlr.vl Junuarr One- or Tiro-Famih•D,relling I' 210V /1 �l This Section For Official Us Only 1 Building Permit Number: ate ied: Signature: Building Connnissiuned lnslx or or uilJings Date - f SECTION I: E INFORMA TION 1.2 iAes e & el msIl P er1?� )d nc> h L _ L l a Is this an accepted street?yes_ no Map Nunther — Parcel-Number -- 1r4 Property Dimensions: _::. --},.-•..-..,-• -_ _:. - `1.3 Zonitiginfoitriation: _ "' Pe y Zoning District Proposed Use Lot Area(sy ft) Frontage(11) 1.5 Building Setbacks(ft) Front Yard Side Yards Rear Yard ! Required Provided Required Provided Required Provided 1.6 Water Supply. (M.G.L c.40.§54) 1.7 Flood Zone Infortnation: 1.8 Sewage Disposal System: Zone: _ Outside Flood Zone'? Municipal❑ On site disposal system ❑ Public❑ Private❑ Check if yes❑ SECTION 2: PROPERTY OWNERSHIP` 2.1 Owner`of Record• G�GZ E7'1 (3 !� Name(Print) Address for Service: Signature Telephone SECTION 3: DESCRIPTION OF PROPOSED WORK2(check all that apply) New Construction l7 Existing$uilding❑ Owner-Occupied ❑ Repairs(s) ❑ Alteration(s) ❑ Addition ❑ Demolition ❑ 1 Accessory Bldg. ❑ Number of Units_ Other ❑ Specify: Brief Description of Proposed Work': G-P L P--L F R CEP-1-S WIJ ALL Pvl)D /Q zk/ i hTAYL. /-►-K I rk G Lam' _ SECTION 4: ESTIMATED CONSTRUCTION COSTS Item Estimated Casts: Official Use Only (Labor and Materials) L Building $ I. Building Permit Fee:$ Indicate how fee is determined: i ❑Standard City/Town Application Fee 2. Electrical $ ❑Total Project Cost' (Item 6) x multiplier s 3. Plumbing $ 2. Other Fees: $ 4. Mechanical (HVAC) $ List: 5. Mechanical (Fire $ Total All Fees: $ Su ression) Check No. Check Amount: Cash Amount: i 6. 'Fotal Project Cost: $ ©Q ❑Paid in Full ❑Outstanding Balance Due:._ I frVQ A�� SECTION 5: CONSTRUCTION SERVICES 5.1 Licensed Construction Supervisor(CSL) 1144 2-C>q J lD License Number Es iration Date Name of CSL-I IolJer List CSL Typc lice below) C� S YA I a M/4-� T Description 4JJn fss ,i �/ G Unrestricted to to 35.000Cu. Ft.) R Restricted Idh_ Family D.cdlm S M Mason Only Sign S-7 V 14 Got RC Residential Roolin Cuvero Telephone INS Residential Widow and Siding SF Residential Solid Fuel Burning A)rhancc Inatallauou D Residential Demolition 5.2 Re istered Home Improvemeat Contractor(HIC) Lc� IK6Yl_ J G L .HIC Compan Nairn or H1 Registrant N Regislr tint Nunther IG [y3r+ i� S�zffi^ 1 Mn �p Addres� _. 5.79. :L4b � .. . _._= •port on 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 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 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 live to is ilding permit application. Signature of Owner Date SECTION 7b: OWNER'OR AUTHORIZED AGENT DECLARATION as Owner or Authorized Agent hereby declare that the statements and information on the foregoing application are true and accurate, to the best of my knowledge and behalf. Print Name Signature of Owner or Authorized Agent Datc (Signed under die ains and penalties of r'u ) 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(HIC)Program), will not have access to the arbitration 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 CMR Regulations 110.116 and 110.115. respectively. '. When substantial work is planned,provide the information below: Total Floors area (Sq. Ft.) (including garage, finished basement/attics,decks or porch) I Gross living area ISq. Ft.) Habitable room count Number of fireplaces Number of bedrooms Number of bathrooms Number of half/baths Type of heating system Number of decks/porches Type of cooling system Enclosed Open -- 3. "rotal Project Square Footage' may be substituted for"Total Project Cost"