42 AURORA LN - BUILDING INSPECTION ...........
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Front Yard..,Y' + Side Yards= .+
.j_Requlred Provided ',Required Provided eq
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s ESTIMATED TI2[1CTION COSTS
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-(Laborand Matenals) BiiIdi6 P&iwfRj-$ Indicate haw fee is determined
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3 oral Project Costs
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Check NW Cheek buntGish Amdunt
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6 Total Project c i
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' a f � sr y T . •s-wf >"� r A:Descn eon':.
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5' R H me I v ` Confrsctor`(HIC)
01.HIC Re scant ame Registmd�N`umber -,:_ r
__,. ` ` SECTION 6 `WORKERS'COMPENSATION'°INSURANCE AFFIDAVIT(M G L.c 152.�$t2SC(6)) -
;' aWarkers Coinnsuuan Insimnce affidavtt mus`tbe comptet�ed aiid submitted with`thisrapplicanon Failure ni prttnde
this affidavit will result m the d'emal of the Issue f fhe bwidmg permit r r
�}s `s SEC�ION18 OWIZATION TO BE COMPLET®WHEN,
NERFAUTHOR r .
r- � vOWNER S AG1�IT.OR CONTRACTORAPPL]IES FOR BUILDUVG PERMIT
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fdrl 'sG'P as Owner of the subject property hereby
authonie . L rdfi�
fo act on my behalf in all mnuers
ielative to; k authotiud b tlds 6Wld�ng'permit apptieation
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SECTION 7b OWNERt OR AUTHORIZED AGENT DECLARATION L
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I rY ' ae Owne► thoriud A hereby declare
_ that the statements and mform¢uon on th .bregomg appticatton arc true and accitrate to a best of my knowledge and r'
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Sign _ Owner or-Ruthorized Agem t 1. ,s Dare -
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l An Ov ner who obtains a bwldmg permit to do his/her owwwork,7or an ownerwho htrrs an unregistered wntrnttor
(net iegtaterc fhe Aome Improvement Contractor(HIC)'Program) wt ;W. , nmuon }
rri " __�,�� pmg�m o ygtmiamy,fund u�erM()L::cf 142A.Othertmpbttunt infartoution on the HIC Progruth and 5 � � -'
k CotistructionSu -rvisac licensing(CSLS.caa he.fOUnd,n 7g0ECMR ReBulanonS 1 IO Rt;wtd 1 LO RS respectively 'x
s 2 r When`subsfnatial .Work is plashed provide the mfo(mmton below yt
Total flnm%area(Sq R) t c4 s " :(meludmg giimge finished bosetiiant�amcs desks ur pdrehl +
t u_ blr Habime
Gross living mea(Sq,EcS -
' +' Ndmbvoffireplaces + Number.ofbedritoms ' -
Niuntifif bnthraoms NumbernF:half/baths r '
F Iype of hecting sysiem'n ` Number of dCCka/porches
Type nfyiaoling system'
'x 3 ]"1 otcl Pmject Sgti3re Faoinge.!#§be subshtmed for Total Project Cost leZ
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