24 AURORA LN - BPA10-329 REPLACE WINDOWS & DOORS y The Conunomcealth of Massachusetts
Board of Budding RcgulatiunS anti Slandards %II'NItI.P.U.I'll
1, Massachusetts State Building Code. 780 CNIR. 71" edition I'.SId
G
(� Building Permit Application To Consu•uct. Repair. Renos ate Or Denwlizh a krri.w,0,ulmrn
One- or Tiro-Funtily Dwelling )
This Sect n or Oi'tici se my — —
Building Permit Number: D to A i
SI°nal alY: � ,�—�----
Building Cunuvissiuned Inspet or of Bur dine Date
SECTIO S T INFORil1A'rION
L1 operty \ddress: , 1.2 Assessors Map & Parcel Numbers
�I A ✓i o —
blapum Nher par"[ Number
I.la is this an accepied sire:c:' )'Is— I:n_ ._.—.
1.3 Zoning Information: 1.4 Property Dimensions:
Zoning District Proposed Use Lot Area(sy li) Frontage(li)
1.5 Building Setbacks(ft)
Front Yard - Side Yards - Rear Yard
I Required Provided Required Provided Required Pruv ided
1.6 Water Supply: (M.G.L c.40, §54) 1.7 Flood Zone Information: 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 Recur
mr r i l i, 0 F- �a rneS ftlaft5m � y ►�l a rn�a� �
Name (Print)U Address for Service:
q '18 -�IUi -0�q ' r —
Signature Telephone
SECTION 3: DESCRIPTION OF PROPOSED WORK'(check all that apply)
New Construction ❑ Existing Building ❑ Owner-Occupied ❑ Repairs(sl ❑ Alterutirm(i) Addition ❑
Dcmol:don ❑ Accessory Ride. 0 Number of Units_ Other ❑ Specify:`
Brief Description of Proposed Work':
1t'1 `)±CA A _ LeotA ) .P C)i- l7 C
SECTION 4: ESTIMATED CONSTRUCTION COSTS
Item Estimated Costs: Official Use Only
(Labor and Materials)
I. Building $ Co I. Building Permit Fee: $ Indicate hum fee is deli,mmed:
❑ Standard City/Town :\pplication Fee
2. Electrical $ ❑Total Project Cost' (Item 6) x multiplier x
i
1. Plumbing $ 2. Other Fees: $ I
4. Mechanical IHVAC) $ List:
5. Mechanical (Fire S 'total All Fees: S-
S'u? ressiuo)
( Check No. Check :\muunr.
j 6. rota' Project Cosh $ 19 V 5l0 • 0 Paid in Full ❑ Outstanding Balance
r
SECTION 5: CONSTRUCTION SERVICES
5.1 Licensed Construction Supervisor (CSL) M�:Z3'3
1 'lY'� Liansc \umhct 'Expu:uinu Date
Nay I of CSL- I to der 5 Lot CSL Type(see hellm)
f Tv e - Descnnion
\J re s L L'nresuictrd up m 3i.000('u. hI.1
R Restricted I Ye_' Fannh D��rlhne
/S iranature N1 Nlusonrn (lnly
'! q 1- 0L-) 2y RC Residential Moulin"('o�anm:
Telephone Ns Re>l&w1al Wind'm ,md Sidutn _
SF Rrs)Jemi;tl Sali.l Fuel Bunune \sth:mcr In,l.illaw�n
p Residential Denuowon
5
1 i rReter �lonneI�nLttprSeme%<untractorl111C) 16I
I
III C tpany Tome u HIC e cis ram Name Registration `umber
l Addr s '/
9 9g•-N I-DY-4 E. piratiun Date
7lignatu4re Telephone
ORKERS' COMPENSATION INSURANCE AFFIDAVIT(M.G.L.c. 152. § 25C(6))
n Insurance affidavit must becompleted and submitted with this application. Failuretoprovide
t in the denial of the Issuance of the building permit.
Signed Affidavit Attached? Yes ........ No........... ❑ -
SECTION 7a: OWNER AUTHORIZATION TO BE COMPLETED WHENR'OWNES AGENT OR CONTRACTOR APPLIES FOR BUILDING PERMIT
Ilmt,,.... 5 as Owner of the subject property hereby
authorize Ij 5 r ^� to act on my behalf, in all matters
relative to work authorized by this building permit ap ication.
- 1 Q
G7
1b) �O !
Sik nature of 01wner I Date T
SECTION 7b: OWNEW OR AUTHORIZED AGENT DECLARATION
7 _ cnrl 5 c" rZL as Owner or Authorized Agent hereby declare
that the statemerW and information on Q foregoing application are true and accurate,to the best of my knowledge and
behalf. l
Print Naa
Signature of Owner or Authorized Agent Date
ISiened under the pains and penalties of perjury) -
NOTES:
1=Owner obtains a building permit to do his/her own work,ur an owner who hires an unregistered contractorn the Home Improvement Contractor(HIC) Pro_ram), will riot have access to the arbitrationanty fund under M.G.L. c. l-t_',4. Other impurhmt information on the HIC Program andpervisor Licensing(CSL)can be found in 780 C•MR Regulations I I0.R6 and 110.R5, respectively.
I ?. W'hen substantial work is planned, provide the information below:
Total flours area(Sq. Ft.) iincluding garage, finished hasement/:atics, decks or porch) -
I Gross living area)Sq. Ft.) Habitable room count _
Number of fireplaces Number of hedrooms —_
Number of bathrooms - Number of hult7h;ohs
fvpe of heating system - Number oI decks/ p,rchcs
Type of Cooling System Enclosed Open
7. "Total Project Square Footage- may be substituted tir 'Total Project Cost"