5 TAFT RD - BUILDING INSPECTION The Commonwealth of Massachusetts
Board of Building Regulations and Standards FOR
Massachusetts State'Building Code,790 CMR, 70.edition MLINIUSE.ALITY.
Building Permit Application To Construct,Repair, Reno ate Or Demolish a' RevfsedJannary. '
One=or 7wo-Fa 7y Dwelliri 1, 2008
Tids-Sw4dForlofficiawse Only, .
Building Permit Number ate pplied: _
Signature;
Building Ciiinmiss5onco'Insp=rorofB ild' gs Date
SECTIO :SITE INFORMATION
1,1 Property ss
S. 1.2 Assessors Map &Parcel Numbers
5 a c 2 3 t (01ZL
1.1 a Is this as accepted street?yes no Map Number ' Parcel Number. _
1.3 Zo ng Information- t� 1 1.4 Property Dimensions:
\
Zoning District Proposed Use I Lot Area(sq ft) Froatage(4)
1.5 Building Setbacks (ft).
Front Yard Side Yards Rear Yard: -
Required. Provided ,. Requimd Provided Required Provided -
L6 Water Supply: (M_G_L a 40, §54) 1.7,Mood,Zone Information:_... 1.8 Sewage Disposal.Sysfem:. .--.-.
Zone: Outside Flood Zone?..
Public❑' Private❑ — - Municipal❑ On site disposal system 11
• Cheek ifyeso .
SECTION2: PROPERTY OWNERSHIP'
2.1 Ownerl of Record- I \
u e, 66\ e t� h�v� S T✓n,�__r Qd Brew. OAA ()Ijl� c�
Name(Print) Address for Service: .- - -
Signature .. - - - Telephoner
SECTION 3:.DE.SCRIPTION OF PROPOSED WORK 2(che6k ill thit.gpPly)' .
h'ew E s ^^ n' I O^ y ?e a s ..boars) Lti' dditi C
'�C➢StiL`t:t3l?n ❑ .�.t ..g IIl.TInt'. CD.'ller- u7:c.Y_;-' F3 (S �> ..
6cinolition ❑ Acce'ssoryBld_:❑ Number of Units_ Other L ccify:_. c ' lC1( rNILe_2`
Grief Description of Pro posed Work-:
VnC—(-r r•o e-r jlrn
SECTION 4:ESTIMATED CONSTRUCTION CASTS
Estimated Costs:
Item Official Use Only
(Labor and Materials)
1.Building $ l I- Building Permit Fee:$ Indicate how fee is determined:
2 Electrical $. O Standard City/Town Application Fee
D Total Project Cos?(Item 6)x mulf1pl er x. ..
3.Plumbing $ 2. OtherFecs:.$
4.Mechanical (HVAC) $ List
S.Mechanical. (Fire $
Su pion) Total All Fees: $
Check No. Check Amount Cash Amount
6,Total Project Cost $.i.q gv• O J D Pad in Full 0 Outstanding Balance Due:
SECTIONS: CONSTRIICTX-QW qaW' CES
5-1 Licensed Construction Supervisor(CSL)
Q� 3'0� G—D' 1�
t-ate-n in n C i J'� �Urcutc Number- .Ezpiraton Date. -
Name of CSL Holder�l II 'VorC w,r^ 01603 UsrCSL Type(serbelow) Y< "
Address -
`1G/�� U Unrestricted(Ep to 35,OOD Cn-FL)
Signature: R Rcstncuta 1& rlumly Dwelling.
- 3S1 M MasnaryOnly
S Telephone a .. RC _ Residential Roofing Covcriu
X -
. Residwtial Vfmdow and SldinL.
,. SF Residential Solid Fuel Burning Applizome Installation
. . . . D .Residential Demolition • -
5- Registered'Home 1m rov ent Contractor
11IC Company Name or RIC Registrant N e Registration Number .
Address _... ... .
4 _
Sr Warn - 5�8 - 3S1-a dco Expiration Date . .
Telephone -.
SECTION 6:WORi=.' COMP ENSA110N INSURANCE AFFIDAVIT(M.GS,.c. 152_
Workers GompeasatiDnInsurazice affidavit must be completed and submitted with-this application. Failure to provide .this affidavit wiII result in the denisl of the Issuance of the building permit
Signed Af$davtf fitiachad? Yes :,..----.. [T No..........❑
SECTZON 7a:.0 EIt 1T]T�®RI7ATION TO BE•CE)NIP)ETF1?:
OWN�ER''SuukGr1EI+7� )2li;CONT`RAC ORAPPLIESFAZBIIIId�3N PAR ]IT
I,__1)�P✓\C /n l G' (G 1�� J iy as Owner of the subject property hereby
author-i:.e 121� Oe 0-I to act on my behalf in all matters
relative to work authorized by this building permit application
Sr alum of Owner - Date
S(E�.CI1G)1f b @;3LTER}�Q_RA T.XMW- 13£ BAR TZOItT :' `
�;. l :G n lo'dL✓Li iu�7 ac'OuvernrfcidkntiagdAgentitercby,Jeslste
elite(the ttateinenas and icfarmahon on be
fa:ruotu applicatran aretiircaud accuuaTr;to the est a m;.L-ioarledgc and
behalf
(�
-
.Fnnr Name
Signature of Owner or Authoriz gent�. Date
(Signed underthe pains and pmaltics of perjury) - .
NOTES:
1. An Owner who obtains a building,przmit to do his/her own work,of an owner who hires an unregistered contractor
(not registered in the home rovement Contractor Imp (HIC)Program), will not Have access to the.arbitration
program or guaranty fund under IvLG-L.c..142A-Other impmtamt information on the MC Program and
Comtruction Supervisor Licensing(CSL) can be found in 780`CMR Regulations 11 O-R6 and 11OdU,respectively.
2 When substantial work is planned,provide the information below
Total floors area(Sq.Ft). (including garage, finished basementlattics, decks or parch)
Gross living l ma(Sq.Ft) Habitable room count
Number of fireplaces Number ofbedrooms
Number ofbathrooms Number ofhall7baths
Type of heating system Number of decks/porches '
Type of cooling system Enclosed Open
3. "Total Pmject Square Footage"may be substituted'for"Total Project Cost"