10 CHERRY HILL AVE - BUILDING PERMIT APP (002) � The Commonwealth of Massachusetts
° Board of Building Regulations and Standards Town of
C Massachusetts State Buildin Code, 780 CMR, 7'"edition N'��breham
T�\�'/ � Building Dept
Building Permit Application To Construct, Repair, Renovate Or Demolish a 4I3-596-2800
One-or Tt��o-Funii(y Dive!ling Ext I 18
This Sec�ion For O�cial Use Only
Buiiding Pertnit Numbe � ate Applied: /O • Z/. O�O
� O
D Signature: � l7•� 0 �p
� Building Commiss er ect ' Da[e
� SECTION L• SITE INFORMATION
�\ LI Property Address: 1.2 Assessors Map& Parcel Numbers
�Q JO C'.tierrH /�i /� !�✓Zv� U 2
I.la�ls this an accepted sfreet?yes__ no Map Number Parcei Number
1.3 Zoning Information: 1.4 Property Dimensions:
Zoning Dis[rict Proposed Use Lo[Arealsy ftj Frontage(R)
1.5 Building Setbacks(R)
Fron[Yard Side Yards � Rear Yard
Required Provided Required Prmided Required Provided
L6 Water Supply:(M.G.L c.40,§54) 1.7 Flood Zone Information: 1.8 Sewage Disposal System:
Public❑ Private❑ Zone: _ Outside Flood Zone? Municipal O On site disposal sys[em ❑
Check ifyesO
SECTION 2: PROPERTY OWNERSHIP�
2.1 Owner�of Record: � / /�
/�a�r2rm -rSO�nnI �Ov�ll�� � 0 GtiZfrv� IYi� � /7✓?M1/�
Name(Print) Address for Service: �
q� �s �yS 3 �79
Signamre Telephone
SECTION 3: DESCRIPTION OF PROPOSED ORK'(check all that apply)
New Construction❑ Existing Building❑ Owner-Occupied Repairs(s) ❑ Alteration(s) ❑ Addition ❑
Demolition ❑ Accessory Bldg. ❑ Number of Units� Other ❑ Specify:
Brief Description of Proposed WorkZ: =n STcL 11 GL o�l 5 JC'�.J So /q r S ry S�'�
0 N '1'�'�2 Fra-.aG1t 2 n a �
0
� - sECTroti a: Esrimwre�cc,rvsrzac•i ioN c�s�rs
Item Estimated Costs Official Use Only
Labor and Materials
I. Building $ ��G �� 1. Building Pertnit Fee: $ Indicare how fee is de[ertnined:
❑Standard City/Town Application Fee
2. ElecMcal $ 2 O O p ❑Total Project Cost�Qtem 6)x multipiier x �
3. Plumbing S 2. Other Fees: $
' 4. Mechanical (HVAC) $ List f _�
5. Mechanical (Pire $
� Su ression Total All Fees:$
Check No. Check Amount: Cash Amount:
6. Total Projec[Cost S I �' �QQ ❑ paid in Full ❑ Outstanding Balance Due:
4���9�i�����.���
SECTION 5: CONSTRUCTION SERVICES � �
5.1 Licensed Construction Supervi(s�or(CSL) G$ 6 u7q3 � - ! � — ZO/0
'7—�� _��a5 2 ��Nfi "' � Liccnsc Numbcr Expiration Da[e
!�711Z✓1 \
Name o(CSL- Holder List CSL Type(sec below) � v UJ
�'�� GA3er S�r��e.t
Address T Descn tian
p ' � U Unrestricted(u to 35,000 Cu. FtJ
7�lLg � R RestricleA 1&2 Famil Dwellin
Signamrc M Mason Onl
� 7 � 9a� g�S2 RC ResidentialRoofin Coverin�
Telephone WS Rcsidential Window:vid Sidin
./ SF ResiAential SoliA Fue{ Bumin A liance Installation
/Y�f� S k 0"� �0'B-� "f'�1�� 0'� ' - D Residential Dzmulition
51 Registered Home Impr ement Contractor(HIC) � S� G 6 �
Tl,ew�a s 'D ow
HIC Company Name or HIC Registrant Name Registra:ion Number
71 C;AgDT. S r ,. 6�Jen l,y_r_ Nlt�- q - ! c� - z0 ! d
Address.���µ �^ () �� � ��.� .
/ �u�� �)SZ Expiration Date
SignaNre Telephone
SRCTION 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 resul[in the denial of the Issuance o the building permit.
Signed Affidsvit Altached? Ycs .......... Nc........... ❑ .
SECCION 7a: OWNER AUTHORiZATION TO BE COMPLETED WHEN
OWNER'S AGF.NT OR CONTRACTOR APPLIES FOR BUILDING PERMIT
I , as Owner of the subject property hereby
authorize to ac[on my behalf, in all matters
relative to work a;rt6�n-ized'uy[hia bue�ding p?m±it application.
Si ature of Owner - Date
SECTION '16: OW NER� OR AUTHORIZED AGF.NT DECLARnTION �
� ,as Owner or Authorized Agent hereby declaze
that the starements and infonnation on the foregoing application are true and accurate, [o the best of my knowledge and
behalf.
Prin[Name
Signature of Owner or Au[horized Agen[ Da[e
Si ned under the ains and enaltics oi er�u
IYOTES:
1. An Owner who obtains a building permit to do his/her own work,or an owner who hires an unregistered contractor
(not registered in the Home Improvement Contracror(HIC)Program), will not have access to the arbitration
program or guaranty fund under M.G.L. c. 142A. Other important infortnation or[he HIC Program and
Construction Supervisor Licensing(CSL)can be found in 780 CMR Regularions I 10.R6 and 110.R5, respectively.
2. When substantial work is planned, provide the informa[ion below:
Total Floors area(Sq. Ft.) (including garage, finished basemendattics,decks or porch)
�� Gross living area(Sq.Ft) Habitable room count
, Number of fireplaces Number of bedrooms
' Number of bathrooms Number of half/baths
Type of heating system Number of decks/porches
, Type of cooling sysrem Enclosed Open
3. "Total Project Syuare Footage"may be substituted for"Total Project CosP'