7 CHERRY ST - BUILDING INSPECTION The Commonwealth of Massachusetts
RECEIJac#
CITY OF
Board of Building Regulations and Standar PECTIONAVICf&EIoi
/ Massachusetts State Building Code, 780 Cbb Revised alur 2011
` Building Permit Application To Construct, Repair, RenovattgS WToliol 41
One-or Two-Family Dwelling
[� This Section For Official Use Only `
Building Permit Number: Date.rpplied:
/r7 0 �
Building 011icial(Print Name) , Signature• Date
SECTION 1:SITE INFORMATION'
t.l Property Address: 1.2 Assessors Map&Parcel Numbers
7 CN aQy S'r
I.la Is this an accepted street?yes ✓ no Map Number Parcel Number
1.3 Zoning Information: 1.4 Property Dimensions:
Zoning District Proposed Use Lot Area(sq II) Frontage(It)
1.5 Building Setbacks(R)
Front Yard Side Yams Rear Yard
Required Provided Required Provided Required Provided
r1.6Water Supply:(M.G.L c.40,§54) 1.7 Flood Zone Information: 1.8 Sewage Disposal System:
Zone: Outside Flood Zone? Municipal❑ On site disposal system ❑
lic❑ Private❑ Checkif es❑
SECTION2: PROPERTYOWNERSHW. Owner'of Record:
RUDY ALA20JU S><YEA7 17U4 -
.t7nhme(Print) City,Stat ,ZIP
ildew s; 97B-47^f 8289
Nu.and Street Telephone Email Address
SECTION 3: DESCRIPTION OF PROPOSED WORK (cheek all that apply)
. New Construction❑ Existing Building 13 Owner-Occupied H Repairs(s) ❑ I Alteration(s) ❑ Addition ❑
Demolition ❑ 1 Accessory Bldg.❑ Number of Unitsg2_ Other Ef Specify: UX9T0EA1ZAT1oN
Brief Description of Proposed Work':
NrJLPr rE AYT1[ f FXTERtoR WAL/f ultTH &Au1.0 egUL L� OSE
SECTION 4: ESTIMATED CONSTRUCTION COSTS
Item Estimated Casts: Official Use Only
Labor and Materials) -
I. Building $ 8 i5- d0 I• Building Permit Fee:$ Indicate how fee is determined:
❑Standard City/Town Application Fee
2. Electrical S ❑Total Project Costa(item 6)x multiplier x
3. Plumbing $ P Qther Fees: S
4. Mechanical JIVAC) S - List:
5. Techanical (Fire S Total All Fees:$
Su ressiun)
oc Check No._Check Ammnnt: Cash Amount:
6.Total Project Cost: S ❑Paid in Full ❑Outstanding Balance Due:
M�trJ
SECTION5: CONS'fRUCTIONSERVICES
5.1 ,pConstruction Supervisor License(CSL) CS-1667.l iQ
RQAD DRaJ6FF License Number Expiration Date
N;une of CSL f1ulJer (�
List CSL'fype(see below)
/S 7)aAAMA) ft. Type Description
No. and Street
U Unrestricted(Buildings tip to 35,000 cu. 11.)
lAlf)llEF(�LA /y f) O1P8r7 R Restricted 1&2 F:unil Dwelling
Cily/fown,State 711` M kfasoary
RC Rooting Covering
WS Window and Sidin
SF Solid Fuel Burning Appliances
617.01 1 1 Insulation
Telephone &nail:ulJress D I Demolition
5.2 Registered Home Improvement Contractor(HIC) 116 SOS 16' -
S77PCA 6W7-9 CD - 111C Registration Number Expiration Date
I IIC Company Name or HIC Registrant Name
326i,nrr,.� ON
No.and Street Email address
ran,rc�, ma �aiyA �/7-�9Z-1t419
Ci /I'own�State ZIP -Telephone
SECTION 6:WORKERS'COMPENSATION INSURANCE AFFIDAVIT(M.G.L:e.152:$ 25C(6)).
Workers Compensation Insurance affidavit must be completed and submitted with this application. Failure to provide
this affidavit will result in the denial of the Issuance of the building permit.
Signed Affidavit Attached? Yes .......... No...........O
SECTION 7u:OWNER AUTHORIZAT'ON.TO BE.COMPLETED WHEN
OWNER'S AGENT OR CONTRACTOR APPLIES FOR BUILDING PERMIT'
I,as Owner of the subject property,hereby authorize t7- CO.
t9 act on/my behalf,in all matters relative to work authorized by this building permit application.
��n7u niJ,AM�, JD-9-/f
Print Ovnw s�Name �ectronic Signature) Date
SECTION 7b:OWNERI OR AUTHORIZED AGENT DECLARATION
By entering my name below,)hereby attest under the pains and penaltiesof perjury that all of the information
contained in this application is true and accurate to the best of my knowledge and understanding.
/11u!:t�@ 16-�-�s
Print Owner's or Authorized Agent's Name(Electronic Signature) Dale
NOTES:
I. 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 Contractor(HIC)Program);will egf have access to the arbitration
program or guaranty fund under M.G.L.c. 142A.Other important information on the HIC Program can be found at
�eww mass eov:'oun Information on the Construction Supervisor License can be found at wso�'dos _
2. When substantial work is planned,provide the information below:
'total floor area(sq. R.) `a .(including garage, finished basementlattics,decks or porch)
Gross living area(sq. 11.) Habitable room count
Number of fireplaces Number of bedrooms
Number of bathrooms Number of half/batlls
Type of healing system Number of decks/porches
Type of cooling system Enclosed Open
J. "Ibtal Project Square Footage"may be substituted [or-rotai Project Cost"