30 AURORA LN - BPA-10-388 4 VINYL WINDOWS The Conimomsralth of 14asSJChuscltS
r 130arJ of Building Regulations and Standards %11'NIt IP.�LI'Il"
blassachusrlts State Building Code. 780 ('MR, 7"' ediliu° 11[
>.. air. Kenocate Or Denu,lish a
13uilJing Permit mrt Application To Construct,uuC[, Rrp
One- urTito-FamilvDwelling /. =rru,4 �
This Section For Official Use Only — -�
Building Permit Nurnher. -Date Applied:
f J signature: rZ•w `^-Ct'7 /V _.---------
Building Convuissiuner/ Inspector of 131,111dings Date
SECTION I: SITE INFORMATION
L1 Property :address: 1.2 Assessors Map & Parcel Numbers
L I a Is this an accepted street? yes_ no_ Map Number P:ueel Number
1.3 Zoning Information: 1.4 Property Dimensions:
Zoning District Proposed Use Lot Area(sq ft) Frontage tit)
1.5 Building Setbacks (ft)
Front Yard Side Yards Rear Yard
! Required Provided Required Provided Required Prus 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'?
Public❑ Private❑ Check if yes[] INunicipal ❑ On site disposal system ❑
SECTION 2: PROPERTY OWNERSHIP'
2.1 O, ner o Reco
Zan �r�i 1�tJ �c�- �k) �z�iora (oQp
Namle (Print) p Address for Service:
S i enatu re Telephone
SECTION 3: DESCRIPTION OF PROPOSED WORK'(check all that apply)
New Construction ❑ Existing Building ❑ Owner-Occupied ❑ Rcpairs(s) ❑ Alteration(s) ❑ Addition ❑
Demolition ❑ Accessory Bldg. ❑ Number of Units_ Other ❑ Speedy:
Brief Description of Pro eW W.yrk':
lf�S7`l O/' � PGr1 1//rll /,f / 1
SECTION 4: ESTIMATED CONSTRUCTION COSTS
Item Estimated Costs: Official Use Only
(Labor and Materialsl
1. Building $ /a � 1. Building Permit Fee: $ Indicate hum lee is determined:
❑ Standard City/Town Application Fee
?. Electrical $ ❑Total Project Cost (Item 6) x multiplier x _
i
3. Plumbing S 2. Other Fees: S /
4. Mechanical (IFIVAC) S
List:
5. Mechanical (Fire S ---
SuM ressiuc Told All Fees: S-
Check No. Check Amount Cash .Anton:__._.. j
j b. Total Project Cost: S q8�q7 0 Paid in Full ❑ Outstanding Balance Due:___..
SECTION 5: CONSTRUCTION SERVICES
SECTION
5.1 Licensed Co»stntctiott Supervisor (CSI.) 57-7
Chrl -tip 0r Liccn.�e Numhcr Isi��(,/it�iu'nn l :ue
'Dreg a(CSL I olde
I_ut C'SL'I\pc isa•hclo,vl
I'v e Description
L L'nrestnctcd to i tip 1�.(N)0 Co. Ft.
r R Restricted 1&2 F:muh D%kelling
CSut.nau rr [J M %lasonn Unh
RC ResiJential R,r1iline Cm Crm„
Tclephone \\'S Rcnidrntial \Vindo„ .uid Sidom --
SF I(Caddlllial SahJ hurl Burnuig \p phanrC lu�tall.0 wu
D Readrilllal Ucmoluiun 5.2 Regis red me Ice rovemt Contra•tor IIIIC) /(Jz(A O l Q
HI `olip:m Nana a IIC Registrant Name Re_utratiun Nuniher
Add
Signature Telephone
SECTION 6: WORKERS' COMPENSATION INSURANCE AFFIDAVIT (M.G.L.c. 152.§ 25C(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 Issuance of the building permit.
Signed Affidavit Attached'? Yes .......... ❑ No ........... ❑ -
SECTION 7a: OWNER AUTHORIZATION TO BE COMPLETED WHEN
OWNER'S AGENT OR CONTRACTOR APPLIES FOR BUILDING PERMIT
1 in. as Owner of the subject property hereby
authorize to act on my behalf. in all matters
relative to work authorized by this building perm) /pplication.
b 9
Signature of Owner I Date
SECTION 7b: OWNEW OR AUTHORIZED AGENT DECLARATION
.- 1, C'hr/ .S �(_. L z �/_,f , as Owner or Authorized Agent hereby declare
that the statements and information on theU'oreguing application are true and accurate, to the best of my knowledge and
behalf. (—'_
Print Name
Signature of Owner or Authorized .Agent _ Date
(Signed under the pains and penalties of er'u )
NOTES:
I. An Owner who obtains a building permit to do his/her own work, or an owner who hires an unregistered conlractur
(nut registered in the Home Improvement Contractor(HIC) Program), will not have access to,the arbitration-
program or guaranty fund under M.G.L. c. 112A. Other important information on the HIC Program and
Construction Supervisor Licensing (CSL) can be found in 780 C'MR Regulations I IO.R6 and I IO.RS, respectively.
'. When substantial work is planned, provide the information below:
Total flours area lSq. Ft.). iincluding garage, finished,hasement/attics, decks or porch)
Grass living area (Sq. Ft.) Habitable room count
Number of fireplaces Number of bedrooms —_
Number it bathrooms - Number of hair/haihs
fvpe of heating system _ Number of decks/ p,,iche.s
Type of cooling system I:nclusrd _Upr❑ ___— _. __
3. "Total Project Square Footage" may be substituted lot "Total Project Cost'
_J