18 CHERRY HILL AVE - BUILDING PERMIT APP The Commonwealth of Massachusetts l
t BOard Of Molding Regnlalions and Standards F( rlt
' \II 11I1 111.\I I `1
\ Ntassauhusetts State Building Code. 780 CMR. 7°i edition
Building Permit Application TO Cons LICE. Repair. Reno%ate Or Demolish ;l Krt,. J./,nnnu
�� (ht • rTit v-Funilt Durllin
l'hi. Sect n For Official Use Only
Building tL
mher:
.SignatureCuinnu„nnn•ri tr of Buildings Dare �. v• r7
SECTION I: SITE INFOR.NLC'1'ION ------- —
LPopertyAd ress: 1.2 :\ssessersSlap & Parcel Numbers%I.� Numhor P,u,.cl .\uinhcr
s this an accepted ,trees'. yes no_ �P
1.3 Zoning Information: I 1.1 Property Dimensions:
Zoning District Proposed Use Lo( Area(sq It) Frontage I li) --
1.5 Building Setbacks (ft)
Front Yard Side Yards Roar Yard
Reyuin•J Provided Required Provided Requited Pro,idcd
r16Water Supply: LM.G L c. q0, §54) 1.7 Flood Zone Information: L8 Sewage Disposal System:Zone: _ Outside Flood Zone?
c❑ Private❑ Check if yes❑ Municipal Won site disposal sysicm ❑
SECTION 2: PROPERTY OWNERSHIP' p
2lObwng�of R�tiofd:
C.��
Name (Print) Address for Service:
c� y 7,?—9 7 9- /.a-V 3
Signature Telephone
SECTION 3: DESCRIPTION OF PROPOSED WORK (check all that apply)
New Construction ❑ Existing Building Er Owner-Occupied ❑ Repairs(s) Alte r.Ltion(s) ❑ AJditi,m ❑
Demolition ❑ Accessory Bldg. ❑ Number of Units_ Other ❑ Spectly: t�
Brief Description of Proposed Work'':
SECTION J: ESTIMATED CONSTRUCTION COSTS
Estimated Costs:
Item Ofrcial Use Only
ULabor and Materials)
I. 13uilJing S 1�.�9t1 �'-� 1. Building Permit Fee: $ Indicate how fee is JCIel In is J: i
❑ Standard City/Town Application Fee
?. F.lectricul S ❑'total Project Cost (Item 6) x multiplier x
1. Plumbing S 2. Other Fees: S
4. Mechanical IHVAC) $ List:
5. Mechanical (Fire 5 -----------
Su r ressiun) Total All Fees: S
�y V Check No. Check :\mount: _ Ca,h ,\mOunl
0 Fotal Project Cost S ���� 0 Paid in Full ❑Outstanchng Bol:uxe Doc: _
SECTION 5: CONSTRUCTION SERVICES
SA Licensed Construction Supervisor IC:S1.) o ,
MEN —71ber --- - - a o
1_Lcn,e ,Nuniher I[spi ralnnl Ddtd { l
\ante ,d( 51.- I IoIder I.lot CSL l\pe nec hclaw I _- _
l llu c,UlelCJ lap In :5.1N10( u
-- --_ -- f_V— R Re,tooQJ I F2 F.tmth Dt�:lhne —j
.S lgnauirc ..\I \� I:uonn Ihd, _—
_ R:,IJ:oral Huuline ('oriel ale
fcl,'phuue N.S Rdvdrnilal \\uldt... and .11J III
/@ Q SF Re,IJeuual 5thJ P.icl Buillnl„ \ „L I_in.c I_nl_dl,itn l_ti
5.2 K istered Ilumr �overnent Contractor 011C1
Hqr
I11C C'ongrmv Nun)e or 111C Regutrmu Name —� Registration Ntoolici
_ /42- v�' ca-Lonsl F�wC Syt�,�isa�roz ya-�L� 5 — �"yam .
cadre„ 1
I Slgnawrr I'elcpinmc _
SECTION 6: WORKERS' COMPENSATION INSURANCE AFFIDAVIT (NI.G.L. c. 152. § 2506))
Workers Compensation Insurance affidavit must be ctrmp leted and ,ubmi Ited cal I this applic at n n. Fa l are at pro,ide
this affidavit will result in the denial of the Issuance of the building permt.
Signed Affidavit Attached? Yes .... O :Vu ....._...-
SECTION 7a: OWNER ALITIIORI'ATION TO BE CONIPLETED WHEN
OWNER'S AGENT OR CONTRACTOR APPiIES FOR BUILDING PERMIT
i [, �-j p-r.r A _-- _—. as Owner of the euhlecl property hereby
I authorize behalf. III In,ntrn
re!atn ..e , '.vork authorized by iin, burl In ,-_ ermir ❑pplic. I n..
Signature of Owner
SECTION 7b: OWNER' OR AUTHORIZED AGENT DEC'LAKATION
-- I
� ,Dj� 1 64Y A —_. as Owner or Authorized Agent hereby daclaie
that the statements and intitrmatiun on the 1liregeing applicawin are true and accurate, to the best of my knowledge and
behalf.
Print Name -
Sienature of Owner or Authorized .Agent arc
I Signed under the 2ains and penalties of per u I
NOTES:
1. An Owner who obtains a building permit to do his/her own work or an owner who hires an uniegisteied contactor
(not registered in the Hume Improvement Contractor (H1C) Program), will not have access to the :whit auun
program or guaranty fund under M.G.L. c. 1�1'_A. Other important information on the HIC Progt-.un and
Construction Supervisor Licensing ICSL) can be found In 780 CMR Regulations 110.R6 and 1 I0R5. rr,pectoey.
' When substantial work is planned. provide the information below:
Total Hours area ISy. Ft,I (including garage. finished bd,enien Uatnc,. decks or poit:hj
(';ro,s living area ISy. Ft.) Habitable room count
Number of fireplaces Number of hedroom, --- —_-- —
Numberof hdthiooms Number of halt1hath,
I',pe of healing ,v,tern _ —_-- Number of deck i potncc,
I vpe It cooling
3 "i'otal Prnjert Square Footage' may be ,ub,ututed fiir Turd Prolea C'o,t" —___