0004 ROOSEVELT ROAD B-10-581 & B-2010-565 r hq;C prnriton�.�alt ai M�s3a��hUsc ie �p �o�,.'°
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Bufllirn Permii hC01i "", 0 Cori' t�ep rr, Rtlio�el(C.Or . I I. ah r'
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s Map At RsnN Nurtbers
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no PO Nup1 + parcel Nmnber
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Frbrit Yard . side Yards`
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pamolitiori . Aeoifsory Y.
NO Description OM,eposed,wank
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SBCTtOfV Ir E�TIICIAT�b COpISTRIlC7IQN,OOSTS
".ElfAMlaled, osis: i Omeld Use On F
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�� 1 ideli hON.fee Is dtlermined:
, f ' w', 1 Bui141b�Fernlll FeeFee f,, -�_ �;; I
fl Slindrlrai Crty�tow!1 Appllcatlo�n Fe!' f
1 Elecracd, f ,. ,
:'.O Toles' ecti Cosir(Item 6)-;mI+,, hil►liet ��_ �
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") Plumbing
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u reason' _ " Cash jlmounl ' "
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h total Pfe�ed!Co#!c' S �',e ..b pgld Pail y CJ Qur6ndlne i3�hipce Dqt
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SECTION"S: O ilisl tuctioN sEltvict5.
51 Licensed Con rtictlon Supers-is r(CSLj
r. fa� �[ // �,�" L icense vulnb►r'<` f cpiruho Pate
N�eoRilG� t'SL• 1q1��,��/� - •l¢W�'�✓5+�� L�dt•Sl.Typel.n.1K'lo�r)
- •. �.. De n non
A_J e U Unres net d •u re:}!000 t o Fr.
r
R Restr cted I`Al'F tl DMdli
Signature 11 Mason Only
3I' RC Resident at lloolin Covenn
' WS. Residential Window and SWin
firtephone- z
3'F Residenhsl3o rd FiYel 9uniin A li ance linmllojon
s Q Residential Denrout
5.2.Reglltered,fl 1 prow` it Contrsefor(HIC) `
HIC y N w NIC e0ISlranr N a isrrah Dluinbe
3t Y 3 3 Expiration Dote,;
Si Telephone __� ♦
SIC TION 6e WORKERS'COMPENSATION INSURANCE.iF'PIDAVIT(M,C.L.e.M O 3SC(0)
Workers Cornpenseiioh lnsursnce aiidaivit must ht jf i4leted ond'subrnined.with this epplicstidn.:Failure to provide
this sttidowit will result in the denistof the lasusnce of ilding,permit., r, "
SignedA01devil Alfached'r .; Yes No CI .•
OWNER AAT PPLIES Ir O PLET D WHEN
E.CPION Tat ING PlER1NIT
` `OWNBIfI's AGENT OR CONTRACTOR
} ' �;G�•-''F` �J/�''�:' .::vrsd Qwner of the subJeetptelperty hereby
eutlwriia �'ti M rlse on my Itehalf,in all matters:"
n ladvt!eto worktbofized by diis building permit applicslion
of Ow or
SECTION 74:OWNER,r_OR A UTNORI�ED AGENT DECIri1RA►'l IOPI' -
�. ;Tu Ownp oR}luthor ted Agent hereby deplaro
Jh#t the ststementi and tnfa ianoti 4n die foregoing application are•true wid-aeeurate,to°the best o(my kndwledoo and
behalf.
Pnnl Nsmo.'
For or Aathaitsd Agen- `emu
f 5r under,thepainsand eltfes of A
l NOTEs: `
FuWtan
wner who,bbisins e'bullding permit to do'hiAer oust wont,or in ownet who hirer ao unrxgistered ctlntractor
egisiered in the Home-lmpravement to,trecit, (RIC)Prosta.16).will-�have access io the arbitration
sm`or gaaranty fiend under hI•G:L `e, 142A, Other,important informstfort on.the W1C proRam and
i ntelioti Supervisof Lifrnairig(fSLI e�e.be found nJ80 CMR Rj 'litidns.l10,R6 and I I'0.R?,respectively.
+ sub;<tantlai wos area(Sq.F0 (ineludrng gauge finished'basemendattics,decks dr?porch}'g area(Sq• f l 1 aitrcountdumber oftireplaces-bsthtbem>t �t,mber of decks!,riorche
type of beating cy'Ste!!t .�
Endoedt3pen
i , typtofcoolrng cylttm' - .._
) , rotoi Proleel Syuare Fuotsge"may:hs'w1+.trtui J for;'Tuiil Proiectfii,t;"
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