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13 CEDARVIEW ST - BUILDING PERMIT APPS Lt cr-- 'rise Commonwealth of Massachusetts - I / Board of Building Regulations and Standards iN, PECCI'WF6 'Ei0 se Massachusetts State Building Code, 780 CMR Revised.Nur dS.hjr10/- 11 VICES Building Permit Application To Construct, Repair, Renovate Or Demolish a 1 1S DEC —2 P I: ( 9 One-or Two-Family Dwelling This Section For Official Use Onl 1 Building Permit Number. Date Applied: l(� 77 ( -DuilJing Official(Print Name). Signature: - Date (� SECTION 1:SITE INFORMATION` Cv 1 I.1 Property Address: 1.2 Assessors Msp Rr Parcel Numbers 11 1.[a Is this an acce ted street9 yes no Map Nwnber - Parcel Number 1.3 Zoning Information: 1.4 Property Dimensions: Zoning DisUict <• P.ruposed Use - Lot Area(sq R) - Frontage(R) 1.5 Building Setbacks(fi) Front Yard Side Maids Rear Yard ReyuireJ Providal Required I Provided. I Required Provided 1.6 Water Supply:(M.O.L c.40,§54) 1.7 Flood Zone Information: 1.8 Sewage Disposal System:' Public❑ Private O.- _ Zone: — Outside Flood Zone? Municipal O On site disposal system O Cha9c if SECTION-: PROPERTY:OWIYERSHiP! 2.1 Owners of Record: N � v re(Print) - City,State,ZIP `TI,hN• � No.and Street Telephone Email Address SECTION 3:DESCRIPTION OF PROPOSED WORKS(check all that apply) New Construction O Existing Building O Owner-Occupied ❑ Repairs(s) O 1 Alteration(s)AO Addition O Demolition O Accessory Bldg.0 . Number of Units_ Other O Specify: Brief Description of Proposed%York-: �� e SECTION 4:ESTIMATED CONSTRUCTION COSTS Item Estimated Costs: Official Use Only Labor and Materials r2. building ( I. Building Permit Fee:S- Indicate how fee is determined: O Standard Cityfrown Application Fee Electrical S El Total Project Cost (Item 6)x multiplier s 3. Plumbing S 2?Qther Fees: S 4.�Icchanical (HVAC) 5 List: 5.\ke:hanical (Fire S Total All Fees:S Su ression) Check No. Check Amount: Cash Amount: G.TmCtl Project Cost: S �� ❑Paid in Full ❑Outstanding Balance Due: i-i—� ©Qbtta2. Gni P . i2'EQvr_.ST — (—tl,�fJ P,�'� MCf=.t�h4 I�IPcSuNi�l2v� SECTIONS: CONSTRUCTION SERVICES 5.1 Construction Supervisor License(CSL) �.�_ Oct da 9 z1 31 'L� License Number Expiration Date Name of CSL Holder List CSL'fype(see below) � No;J Street Type,. . .. . Description ,,. O\qO U Unrestricted(Buildingsa to SS 000 cu. 11. 1 QA\k to)PC R Restricted 1&2 FamilyDwellin City/Town,State,ZIP M Masonry RC Rooling Covering WS Window and Siding %eA.ta(✓ SF Solid Fuel Burning Appliances �`J 5,042` ie--Xt-7 1 Insulation Telephone Email address D J Demolition 5.2 Registered Home Improvement Contractor(HIC) `Z35S3 3/l0� HIC Registration Number Expiration Date IIIc Company Name or I IC Reg�slrantName rte` 7c1�. l s�,.C�11.\1�3TLR�] -r- 'lk' Z�O Ai No.and Street Email address e*Ak3fJn 1"lA ® 91kr' 7 Ci /Town State ZIP Telephone SECTION 6:WORKERS'COMPENSATION INSURANCE AFFIDAVIT(m-P4 c.I52 §2$C(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 Istuance of the building permit. Signed Affidavit Attached? Yes .......... No...........O SECTION 7a;OWNER AUTHOR1_.,., N TO BE.COMPLETED.WHEM ,, OWNER'S AGENT OR CONTRACTOR APPLIES FOR BUILDING PERMIT 1,as Owner of the subject property,hereby authorize .tty� t9 act on my behalf,in all matters relative to work authorized by this building permit application. CNS Print Owner's Name(Electronic Signature) Date SECTION 7b:OWNER!OR AUTHORIZED AGENT DECLARATION By entering my name below,)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 any knowledge and understanding. Print Owner's or Authorized Agent's Name(Electronic Signature) Date NOTES: 1. An Owner who obtains a building permit to do his/her own work,or anowner who hires an unregistered contractor registered in the Home Improvement Contractor(HIC)Program),will LM have access to the arbitration program or guaranty fund under M.G.L.c. 142A.Other lmpb;ant mfonnaTion on tWTIICl'rogram—canbe ou d tat- www.mass.eov'oca informalion an the Construction Supervisor License can be found at www.mas� 2. When substantial work is planned,provide the information below: Total floor area(sq. ft.) N (including garage, finished basementtattics,decks or porch) Gross living area(sq. 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 ). "notal Project Square Footage'may be substituted for"'notal Project Cost" !,a��a, a >• °,t',r ;� ,'<,ea�i,�sf, a•.� aa �,k�r°aa� N+ 4� 6t 1 a8 YAy V 1 4 • � �I Soo ( S l of 111oZ �, . Z a 4 4 4 \° !4 Will 15 Ot ° j1{ It�o¢� f V1y��7 tpb„ ., 1 , g� • C A/ :Z E �' Wi`n`p'm C� 4 { Eat e ) m ` �4 =�aC4g 1 Oy1 ��jlti Ce Js o{ 1 tl � vJo , e �AAAAAiii ` �N,1 4 ¢ �Y + l cp FEWO t��, d` �d •tP f�• rl�•� 4� t� i •rd�4� 1 d� (it�` i i I ,Z-rW C,�kU5ZV - N-IF�tiJ CONIT TOOK C)OT � 35 � ` 'rhe CommonwealthofMassachusetts RECEI U 4 / qtfs Board of Building Regulations and Standards iP�SPECTIOfIf` L SLL'A N1 Massachusetts State Building Code, 780 CMR SA EM Revised A%v 10// Building Permit Application To Construct,Repair, Renovate Or EJAUWd I P 2: 41 One-or Two-Family Dwelling This Sedion ForOlBeial Use Only Building Permit Number. Datil.Applleds Building Orrcial(Print Name) Sipnaturc Date SEC ETON is SITE INFORiNIAT16N' 1.1 pe ty dress:— 11 Assessors Map Sl Parcel Number 1.1a Is this an acre ted streetV9 Yes no Map Niaober'' Peal Number 1.3 Zoning Information: 1.4 Property Dimensions: Zoning Distdct Proposed Use LorArea(sq 11) Fronmge(B). 1.5 Building Setbacks(R) Front Yard Bide Ymrb. Rear Ya:d • " ReyuireJ Provided bed Provided Provided 1.6 Water Supply:(M.G.1,ci 40.§54) 1.7 Flood Zone Information: 1.8 Sewnge'DuposelSysit Publico Private Zone: Outside Flood Zone? Munici�O On site disposed system O . Ctiedcif : O.• ,-. . . SECTION I: AROPERTY;6WNERSHIP4 2. nerr of Record: " ZIP No.and Street - Telephone Email Address SECTION 3:DESCRIPTIO P PROPOSED WORK!(cheek all that apply). New Construction O Eiiisting Building Owner 0ccnpied O Repairs(s) O Alrerrtion(s) O Addition O Demolition O 1 Accessory.Bldg. Number of Unirs Other O Speci : Brief Descri tion of Proposed Work. SECTION a:ESTW4►TED CONSTRUCTION COSTS hent Estimated Coss: OfOelal Use Only Labor and Materials i. Building S I. Building Permit Fee:S Indicate how fee is determined: CIStandard City/Town Application Fee 2.Electrical Cl Total Project Cose(item 6)x multiplier x 1. Plumbing S 2'P pher Feb: S 4.Mechanical (FIVAC) S List 5.Mechanical (Fire Total All Fees:S 5 Suppression) Check No. Check Amount: Cash Amount: 6.Total Project Cost: Is 0 Paid in Full ❑Outstanding Balance Due: SECTION 5: CONSTRUCTION SERVICES 5.1 Construction Supervisor License(CSL) ticEnsE Number Expiration Dale g1legibstered old List CSL Type(see below) Tyr - ,:- Description . Street � D Unrestricted Duildin u to 33 OUO w. II.e, IP M MQ 41-3 RC Roogn Coverin0S Window and Sidin SF Solid Fuel Burning Appliances 1 Insulation Email address D Demolition d Home Improvement Contractor(HIC) HIC Registration Number Expiration Date HIC Company Name or HIC Registrant Name No.and Street Email address Ci /rows State ZIP Telephone SECTION 6t WORKERS'.COMPENSATION INSURANCE AFFIDAVIT jt4.q-L a 14§2$C(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 Isluence of the building permit Signed Affidavit Attached? yes ........... No...........O SECTION 7a:OWNER AUTHOIIIZATIOMTO BE.COMPLETED.}WHEN, OWNER'S AGENT OR CONT[tAC1 OR APPLIES FOR'BUILDING.PERhII C' I,as Owner of the subject property,hereby authorize t9 act on my behalf,in all matters relative to work authorized by this building permit application. Print Owner's Name(Electronic Signature) Date SECTION 7b:OWNER,OR AUTHORIZED AGENT 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 ecurate to t t of my knowledge and understanding. %ve O f Print Owner's or Authorized Agent's Name(E Nuonlc Signature) Date 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(1-11C)Program)i will iW have access to the arbitration program or guaranty timid under M.G.L.c. 142A.Other Important tnforma wn on a CYrogra— -- www.mass.eov,'oca Information on the Construction Supervisor License cin be found at w+v+v.mass.ww'dos . 2. When substantinl+vork is planned,provide the information below: 'total floor area(sq. ft.) ' .(including garage,finished basement/attics,decks or porch) Gross living area(sq.11 Habitable room count Number of fireplaces Number of bedrooms Number of bathrooms Number of hal0baths Type of heating system Number of decks/porches Type of coang system Enclosed Open 1 . "Total Project Square Footage"may be substituted for"'rota)Project Cost" Details Page 1 of 1 c 0170a 4 absfie or.ie E-xccutlec 61 ce or ,1Bi Earety and Scr- ,tY iiEOFISS IA 355.GCv llOtrC FtWe.Apondea ensee Details ». -oa ma aph� jrlfaratinn ull ame: TEVE M MORAN " Gender: —� v�jner Name: -- ddress: address 2: City: GROVELAND State: MA , ipcode: 01834 -- o ntr : Urtjted 3tates :Chan : :Exed 7 License Type: Construction Supervisor M. : Licenses Date of Last Renewal: 12/5/2013 : Expiration Date: 12/7/2015 atus: Today's Date: 12/10/2015 _ License: iness As: ^; n e: to Prerequisite Information No Discipline Information Documentum _ Close Window ] ©2011 Commonwealth of Massachusetts Site Policies Contact http://elicense.chs.state.ma.us/Verification/Details.aspx?agency_id=1&license_id=28870... 12/10/2015 _�-