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7 BRENTWOOD AVE - BUILDING INSPECTION
The Commonwealth of Massachusetts Board of Building Regulations and Standards FOR r Massachusetts State'Building Code,780 CMR, 7a' edition MUNICIPALITY USE. Building Permit Application To Construct,Repair,Renovate Or Demolish a Revised Jarruary.. ' One=or vo Family Dwell 1, 2D08 Ti Th 'SetioFor s y . I\113mldin.aPermitNumberature: Building Commissioned Inspector uildings Date . SECTION 1: ORMATION 1.1 Pro erty Address: 1.2 Assessors Map &Parcel Numbers 1.1 a Is this as accepted street?yes= no Map Numbcr Parcel Number. 1.3 Zonin'r;gInformati ; �e 1.4 Property Dimensions: Zoning District Proposed I]se. Lot Area(sq ft) Frontage(ft) 1.5.Building Setbacks (ft). Front Yard Side YaTds Reny Yard- Required Provided Required � Provided Required Provided L:6.Water Supply: (.KG.L c.40, §54) 1.7'Flood,Zone Information:... 1.8 Sewage Disposal.Systems.:- -- Zone Outside Flood Zone? Public❑- Private❑ — Municipal❑ On site disposal system .❑ Check if-yesO SECTION 2: PROPERTY OWNERSHIP' 2.I wpert �tecor \ tGr i (��.: 00 Name(Print) Andress for Service - - Signature .. - Telephone. . SECTION 3aSJESCRIP'd'ION OF PROPOSED WORK'`(eheck all that app)y)". 1,�eu c.GcasG tction ❑ xi •nno..gt rg. O.:: , . nddticr i : - � p:cd - Dern6lilion ❑ -Accessory Bids. ❑ Number onInits Other. pcci(y:_ LCt'i.Gl�cre-' _— Brief Description of Proposed Work'-: - L�3 c vm SECTION 4: ESTIMATED CONSTRUCTION COSTS Estimated Costs: Item Offrr ial Use Only (Labor and Materials i. Building $ { qps . 1. Building Permit Fee:$ . Indicate how fee is determined: u u 2Electrical ❑Standard City/Town Application Fee $. .❑Total Project.Cost'(Item 6)x multiplier x . 3.Plumbing $ 2. Other Fees: $ 4. Mechanical (HVAC) $ List 5.Mechanical_ (Fire $ Suppression) Total All Fees:$ n CheckN'o. Check Amount Cash Amount 6,TotalProjectCost $. "1pS,uo 0Paid in Full ❑ Outstanding Balance Due: ____, z t SECTIONS: CONSTRIICI�N SIDES 5_1 Licensed Construction Supervisor(CSL) \✓•PV�I,I U.t.Number Expiration Date. Name o�(ICSL-H Ider + , `-1(`P-'� ��(` I,JaJ`G' 1nG: d( d Listt:SLType(serbelow)�_. , 6 3 . Address . ' D ` tion - - u Unmstnattd(ri� to%35,00n.Signatw-e .. R Rasu-ieted 1Bc2 FeiMas .OnlRC Rradmtial RooflnTelephone. `� S \X WS' Rcsidmtial WmdoSF- Resid=tial Solid FlianaInstallation Reidential Demoli5. Registered Hpme impp�'ovatt��eat Contractor(HIC) ��t yr \ l�litr3r r� 810 H1C Cpmp�anyNMe H1C Regisonn��a a Registration Number c�:Ra t �l YV u r 4 h�9�u 41n r 6153� _. Address• __... ... - a -.a"�'_ .� . .. . . t yy -354-adlb Expiration Date Si store. Telephone - . . SECTION 6:WOtZEt"re,RS' COIYIPr.NSA'ITON DgSURANCR AFFIDAVIT(M.GS.. r-132.§ 35C(6)) . Workers Compensation'hunlrance affidavit must be completed and submitted with this application- Failure to provide . -this affidavit will result in the denial of the Issuance of the bm7ding permit - Signed Aftidavif Atiachnd? ' Yes :...---:.. MY No.......... SECTipN Ta:OSIER'S7JTKO1#�TIPN TO BE•CpMPT-E ., N`. OWNER'fi'AG/E�NT©1i;1CQNfRACTATz APELIES FOR8I7II ii��E�SR�T.. ' as Owner of the subject Property hereby authorize n n i o✓f to act on my behalf,in all matters relative to work authorized by this building permit application. . Si a'[ure of Owner . .. - .. - Date S(E�CI L ;ORt OR 9YzIs1A ;IiEr } f r 'n V +r5ci T n Duvet nr�cittht nzerJ Agesit+i'errt v rlaFlszt tlra( Hu:Statcn�raLs and information en.t_he foreguina'applicatinn arefiµi-aiad accurate,-to tlielbest tsf my kpouledge and �- - behalf .Frini Nam . . . . . Signature of Owner or Authorized Agent _ Date - - (Si ed undarthe pains and penalties of pmjm - NOTES: 1. An Owner who obtains a building.permit to do his&cr own work, or an owner who hires an unregistered contractor - (not registered in the Home Improvement Contractor(MC)Program), wiin nor liavc access to the arbitration program or guaranty fund under hLGJ- c. 1424-Other important information on the HIC Program and Constmctipn Supervisor Licensing(CSL) can be found in 780`CMR R egvlations 11 OR6'and 110.R5,respectively. 2 Wben substantial work is planned,provide the information below. Total floors area(Sq.Ft.). (including garage,5nishcd basement/attics, decks or porch) Gross living area(Sq.Ft.) Habitable room count Number of fireplaces Number ofbedmorns Number ofbathmams Number ofhalflhaths Type of heating system Number of decks/porches Type of cooling system Enclosed Open 3. "Total Project Square Footage" may be substituted'for"Total Project Cost" q r-r d C,ao - — -