0008 CASTLE ROAD - BPA-05-09 --- ------ ------- I Iic (',annnnt„r,lIt to NLus-Ichtiscu,
t .R Boild"11 Iiu11Ji::c RCglllatIons and S(and.uJ, \11 Nlt ❑' \I i I 1
t 9 %Iassachux•fts State Hudding Code. 'Sit( MR. "" cJllnon
' 1 Buildim-, Permit Applii.111on fu (\,nsntiii. Rrpair. Reno ,xe (h I)Cm,li,li .I
lw7 Ugr III For l)nrllutt�
I"hi.s Section For Official (Ae OWN
_ I
ilwlding Prim NUIth•
to U -
BwW,n lmunn.iuncll It al llwldwg, U.ae
---- SE("PION I: SI'I'll: INVORMA HON -
1.1 Property %ddress: 12 Assessors Map & Parcel .Numbers
Nwilher P.Il.el NOl:Ib"
1.3 Zoning Information: 1.4 Property Dimensions:
I _
1 Zoning Dutrut Prulv.-cJ '',e I m hrea!,q to F; rulape IIL
1.5 Building Setbacks (A) __- _-,-__
Foil Yard Side Yards Rcsr laud —__-
Rryuu cJ Pru,IJeJ Reyuued Prodded Required PIn,Wrd
�-1.6 Water Supply: 04.(; L c 40. §54) 1.7 Flood Zone Information: 1.8 Sewage Disposal System: i
Zone: _ Outside Flood Zone? \tuna al O On .ne Ju,sisal ,y`Irm ❑
Public ❑ Pnvate❑ Check 11 yr,❑ P I
SECTION 2: PROPERTY OWNERSHIP'
21 wner'ofRecord: 9J /z- 6?cl
N.ur: Il'nnti Address lift Ser,ice:
Sign:,uire Telephone
SECTION 3: DESCRIPTION OF PROPOSED WORK2(check all that apply) 1
New Construction O Existing Building ❑ O,sner-Occupied Repairs(s) ❑ :\Iteranonl,( ❑ :\JJllin ❑�
I Demolition ❑ .Accessary Bldg. ❑ 1 Number off Unus--j Other ❑ Specify —
Bnef DescnpuuLn of proposed Work Cezon 51f_c._��_.z.x-2
i
SECTION J: ESTIMATED CONSTRUCTION COSTS
Estimated Costs:
Item ILahor.mJ M:uen:Js1 Official Use Only
I Hold �tg 7 7S"Q,�, Q.0 I Building Permit Fee: 'S_ Indicate h��,s Ice 1, Jetrl 111mcd.
❑ Standard City/Town Application Fee
_'. Iilectncal 5 ❑ Total Prn)ect Comp (Item 6) c multiplier _— , -----.
II Plumbing S '. Other Fees S
.�1 Mechanical Ili%':\CI --
! 5 \lechimc.11 (Fire y
its „rn,innl I T,d.11 :\II Fee,: )_�'�___--
Check No _ l"hec knurtl rt _ l'.nh \nlunu
(I rolal Project Cost S 5-00,0, ! Peed In Full -- .\nt
❑ 1 hnst.unL ne B.J m_ ,e I)ue_
SECTION 5: CONSTRUI'rION SERVICES —
5.1 licensed Construction Super,isur f CSI.1
/•.-_VA�Of
�u ( St. IhdJer
LI,I I'SI. 1,pe i.ii hi low t .. _v62
.__ 4J,1, _�._m/t Q1�70 ( f ❑ mcd I I.
,1-Yy -/ H Hcdlti led LC_' Fat ul, It„illuiv
__ _H( Hi�iJ:nu�I H'.,dute
frlrplt_ tRi�iJ;nU,II Nisi J.... .n:J
I Buuiui`\LL u
�D f R.•.�J:nu.tl Uiin��hu� ii .__._.__—__/
5.2 Registered Home Impru.-emenl Conlruclor t1110
HI('C'ontp.aw \'ante or 111C Registrant Nantc Regi,v-iuun NUluher
kddre,,
fi,puahun D:nc
Signature releph�ne
ECT 6: WORKERS' COMPENSATION INSURANCE AFFIDAVIT(M.G.L. c. 152. § 2504)1
Workers Compensation Insurance affidavit must be completed :md ,ubmitted with this ❑pphcauon. Failure io pnr,ldc ,
this affidavit will result in the denial of the Issuance of the building permit. -
Signed Alfidavil Attached" Yes .......... No _. .. ❑
SECTION 7a: OWNER AUTHORIZATION TO BE COMPLETED WHEN
OWNER'S AGENT OR CONTRACTOR APPLIES FOR BUILDING PERMIT
1. , as Owner of the subject property hereby
authorize to act on my behalf. In all matron
relative to %"nk authorized by this building permit application.
Signature of Owner Dale
SECTION 7A: OWNEW OR AUTHORIZED AGENT DECLARATION
1, as Owner or Authorized Agent hereby declare
that the statements and information on the foregoing application are true and accurate, to the best of my knowledge .Ind
I behalf.
Prutt .Name -
.Signature of Owner or Authorized Agent Date — ----
t tit toed under the aim and penalties of rru I
NOTES: _
I. An Owner who obtains a bulling permit to do his/her own work, or an owner who hires .,it unreLI,trleJ r,,ntra. her
(nut registered In the Home Improvement Contractor (1110 Program). will not have acces, h, Ine ,uhilimlon j
program or guaranty lurid under N1.G L. c. 142A. Other important infi,rmduon on the Ill(' Prouram .Ind
Construction Supervisor Licensing t('SLI can he found In 780 CNIR Regulations 1 IQ.RG and 1 IU R5. rc,pccn%ch I
When ,uhstamial work is planned, provtde the information below� :
Total floors area tSy. his uncludlng garage, finished ha,enten Uatttes. decks or por.h,
tiros% living area tSq. Ft,) Habitable room count
Number III hrcplaces Number of bedroom, _-
Numher ,d h.uhlootns Number of II.JVh.tlh, _
I ,peof heating ,v,tcm NIIlnher ,,lJc,k,ipol,hc,
rope
t "Fol:d Project Syu,Irc Footage" m.n he ,uh,utwrd drt "roLll Protect