1 WITCHCRAFT RD - BUILDING PERMIT APP t litwrd tJ liulldin� R«ul:wuns ,wd SLutJ.IrJ, I t Ill
't t _y \1:usachusclts Slag Budding ( ode. 7S0( MR. 7"' :dwon *,It S'li H, \III 1
Building Per still . lipliealit)n TO ('011SHn0. RCPdir. Rent)t.ne (is DC111 Ji.h a K, . „ •/ :.".... .
\ (hill- I,, Tuvr-/Tamils O utli ts:
f I his Seat Otfiaal l'se UnIY ---
i Bantling Femur Nt iher. )are Applied:
naw rr
It it m 'uimnl..ioneli In.1s•ci 01111 s Dal, -
SF.C'ITON I: .SI 1'E INFORM:\T11)N - - - _
I.I Prop ty \ddress: I 1.2 \ssessurs Nlap r Parcel Numburs
I la 15 This .In aecePled street:' )es Malt NGunhrr Pdiel \wuhel________.--
- - IA Zoning Information: 11.4 Property Dimensions:
Zoning Dt,;rm Prvq>,Led 1'se I Lot :VNl+y 141 - i' nllagc il'lh_.__._, I
1.5
Building Setbacks (ft)
Frunl Yard Side Yards_ Rear Yard
Reyuiied Pro, ded ReyuucJ Provided Raquucd Pit ,iJcd I
i
1.6 Water Supply: i.M G L c. 40. §91) 1.7 Floud Zone Information: 1.8 Sewage Disposal System:
Zone: _ Outside Fksod Zone:'
Politic ❑ Private 13 Zone:
it yes❑ Mumclpal ❑ On sue Jul>,Ival >h slrm
SECTION 2: PROPERTY OWNERSHIP'
2.IN nerlof Record:
_ -. �,�) i"st1a ,uAI k I b9 Fc cc 6 (�- --- i
Ifirms l s Addresstor Sea'sicc
Sign Lure Telephone
�—SECTION 3: DESCRIPTION OF PROPOSED ORK2(check all that apply)
New Conmructilrn ❑ Existing Building ❑ Owner-Occupied I Rep;urs(s) ❑ :\Iterationls) ❑ 1_Addinim O�
Demolition ❑ Accessory Bldg. ❑ Number of Units Uthzr ❑. Specii}.
Briet DesurlPuun tti Proposed kill, �: i
SECTION is ESTIMATED CONSTRUCTION COST'S j
Estimated Cots: j
Vern 'Official Use Only
it ahnr.md Ntatrnolst
I_ BuIlJing 4 z Q L Building Permit Fee: 'S ZS _ Indicate huu rec Is deter mined
�� ❑ Standard City/'fawn :\ppheattun Pee
2. Electrical 'S I
❑ Total Pm)ect ('list (Item 6) t multiplier t ---___-
t Plut ibis 'S i 2, Other Fees: S
F —Mecham al ifl\':\CI 5 - - � Lim
i Methamcal (Fire Taal AH Fees -- -
_---
f 'heck No _ l heck \rrn,um _ l'.nh Vir,to t
r
is fotal Project Cost I )
0 P.uJ in f=ull ._— f)urshmJing 13.0,111.e Uuc
SECTION 5: CONSTRUI'rlON SERN'It'FS
--5.1 Licensed Construction Su pen icor ICSI.)
LI\ilr,e Nt shoe I.\pn.n i,:u U.IIi ♦ _
\.0 nc In ( SI. Ihddir LnI1 51. rt pe„ei hChm I
\JJie
. l 1 nie,tooe'd, u., cm, I1 :
R Rr.0 it lid L:'_' 1'.unilt
li_:wiwi \) \Lion r\ lMh
r,li phniii 111 Hi aJ:ii li.d \\uid"n .aid S:d:l,
�il- — R:soda uli.d 1�ihd I ,iil ISununc \LL:.ins: I_n,i.a l:a:_il. _
5.2 Registered Home Improvement Contractor (IIIC'.)
IIIC C,nup.ur, .Naute or the Rcuisirant Nainc -- — RCgI,IraIIUII \iI II It1C1
\Jdre+,
F\puatwn Date
S ignalure reiepnoiie
SECTION 6: WORKERS' CONIPENSATION-INSURANCE AFFIDAVIT(M.G.L. c. 152. § 25061)
Workers Compensation Insurance affidavit must be completed and submitted with thisnpphcanim. Fadure ❑I plot lde -
this atfidavit will result in the denial of the Issuance of the budding permit. _
Signed Affidavit Attached? Yes .......... ❑ No _..: .. ❑
SECTION 7a: OWNER AUTHORIZATION TO BE CONIPLETED WHEN
OWNER'S AGENT OR CONTRACTOR APPLIES FOR BUILDING PERMIT
1 as Owner of the ,abject property herebv I -
authorize to act on my behalf. In all macer.+
:e!ative to w,nk authorized.by this building permit application.
Si nature of Owner Date
SECTION 7b: OWNER% OR AUTHORIZED AGENT DECLARATION
1, as Owner or Authorized A,,ent 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 Date — ----
I
ISI ,ned under the ains and penjitiesof pedury,
NOTES:
I. An Owner who obtains a budding permit a)do his/her own work. or an,miter w hit hires n
an uregnnl teled c,Ira, wi
(nut registered In the Home Improvement Contractor (1-110Program), will not hdte access to tne .uhiomit.o j
program or guaranty fund under M.G.L. c. 142A. Other important information on the I II(' Program and -
Construction Supervisor Licensing WSLI can he found in 780 CMR Regulations I MR6 end 1 IU R5, ie,peclitcle i
When ,uhstantial %c )rk is planned. protide the information below:
-ro(al floors area iSy. FcI Iincluding garage. finished buseinenUattics. Jerks or poi,h:
Gross livine area ISy. Ft.) - - Hahilable rourn cnunt ---- _.
Number of nreplaces -- Nuntherof hcdroian,
Number,d hathnnvns _-- N'UIr1hCiof 11.1101,1011
NumherldJe.k,ip„i,he,
\pe
7 .:rout) Pngect Square Footage” nt.iy he ,uh,utwed toil r,,r.il Pro)eit t IIsi -