38 CIRCLE HILL RD - BUILDING PERMIT APP Y .
I lie Commonwealth of Massachusetts
Hoard of Building Regulations and Standards Cl SAL OF
n.rd} sr i, Massachusetts State Building Code. 780 C'fvlR tiALh\I
WI 'L,.•• Neri.reJllJral//
Building Permit Application 'ro Construct. Repair. Renovate Or Demolish a
One-or rivo-FamitV Du P•llhn,,
This Section For Official Use Only
Building Permit Number. __ Date Applied: _
Building 011icial(Print Nmne) Si alu Onto
SECTION ;SITE INF RAIATION
1.1 Properl ddress: 1.2 Assessun Alap di Parcel Numben
1.la Is this an a ce tad street?yes no Map Number Parcel Number
1.3 Zoning Information: 1.4 Property Dimensions:
Zoning District Proposed Ilse Lot Area(sy 11) Frontage III)
1.5 Building Setbacks(R)
Front Yard Side Yards Rear Yard
Required Provided Required Provided Required Provided
1.6 Water Supply:(M.G.1.c.40,§54) 1.7 Flood Zone Information: 1.8 Sewage Disposal System:
Public❑ Private❑ Zone: — Outside Flood Zone? Municipal❑ On site disposal wl s),tcm ❑
Check if es❑ P
SECTION2: PROPERTY OWNE IPt
2.1 Ownerl ojC or,Qr 4lll wy
NxmelPrim) s ��� 4/LI City.State,ZIP
Nu.and Street Teiephune Email Address
SECTION 3: DESCRIPTION OF PROPOSED WORK'(check all that apply)
New Construction❑ Existing Building❑ Owner-Occupied ❑ 1Repairsis) ClAlteration(s) ❑ Addition ❑
Demolition ❑ Accessory Bldg.❑ 1Number of Units_ Other ❑ .Specit'y:
Brief Description of Proposed Work-:
SECTION 4: ESTIMATED CONSTRUCTION COSTS
Item Estimated Costs:
(LabJ�alld \I31C Is) OlTlcial Use Only
1. Building S 1. Building Permit Fee: S Indicate 71eeetermined:
2. Electrical S ❑Standard CityrTown Application Fee
❑Total Project Costa(Item 6)x multiplier?. Plumping S /�j j� - ,, Other Fees: S
4. Mechanical ill\.\O 5 Lisl:
Mechanical lFirc --- . . .Su„rvssionl rotal ,\II Fees: S __._ . .I,. Total Project Cnsl: 5 � ('heck Vu. ----(heck:\munml: _ -- ( l:
q ❑ P,uid in Full 0 Outstanding Bal;mce Due:
SEC CON S: C0N5"I'RU("THIN SFRVI('FS
5.1 C'onstructima Su aervi;or License(CS1.)
F'��r
Psp' ;uion 11,
aC+ - -.
Namc oI IL" I IulJcr_�7_.�L' ...... '11 pu Description
No. alld Street
�ry 11 UnreslriclrJ tBuilJin s uil to 11,000 al. 11.)
R Re,tricted IR2 Tamil l Da01111
Cits r I'oen.Stale.LIP ki 1lasun
RC R )tin Covering
_ 'AS Window;md Sidwit
SF InuJI'uulIluming Appliances
i/Jf Y v/ I Insulation
'I'c1e Iuutc Finad address D De..... ion
5.2 Re ors41 Home Impruvenjept Contractor(HIC) l g ( 1.%piraill
I IIC' tc utratlun Nl mt+cr Data
IIIC'Cult)plp p IIC'I a{stram nlu �L ��
Y G—G f 1E1J � s=—
Nu.w1J ' •d L•'mml a Jrcss
Cirytrown.State,ZIP Telephone
SECTION 6:WORKERS'COMPENSATION INSURANCE AFFIDAVIT(M.G.I.c. 152.1 25C(6))
Workers Compensation Insurance affidavit must be completed-gild submitted with this application. Failure to provide
this affidavit will result in the denial of the Issuance oft uilding permit.
Signed Affidavit Attached? Yes .......... No...........O
SECTION 7a: OWNER AUTHORIZATION E LETED WHEN
OWNER'S AGENT OR CONTRACTOR LIE UILDING PERMIT
I,as Owner of the subject property,hereby authorize
to act on my behalf,in all matters-relative to work authori by tP building permit application.
D'JIC to
I'rinl Qwner'f wne( Ieewntc Slgnuture)
SECTION 7b:OWNER' OR AUTHORIZED AGENT DECLARATIO
By entering my name below,I hereby attest under the pains and penalties of perjury that all of the information
contained in this application is true and accurate to the2be f mfy ow;de.,nd understanding.
'> ee yyly�`�w( Al11444'fs r 3 /�
I'rintowQr'+orAulhoniuJ.\gent's Name(t.lccmnucSignature) D c
NOTES:
1. An 0\sner svho obtains a building permit to do his.her own work,or an owner who hires an unregistered contractor
(not registered in the Hume Improvement Contractor(HIC)Program),will na have access to the arbitration
Program or guaranty fund under I.G.L.c. 112A.Other important information on the HIC Program can be found at
W%'% 111.1" n ,v.l Information on the Construction Supervisor License can be found at �;o\ III,
2. \Then substantial swrk is pla�n�n�c��, ro%ide the information below:
Total Iloor area(sq. n.) --- —5# ' .._(including garage, finished bascmca attics.decks or porch)
Gross lising area tsy. it.) __-_ Habitable roum count
\umberoffircli%es - - - --... - \umherol'bcdrooms ..
\umhcrafhathrnunls . _ - . . \umberufhalfhallu
f\pe of heating sk stem \umber ol'Jccks, porches
I I 1 pe iI eoollllg i1 ilelll - I�Ilc loscJ (lhell
i, "fatal Project Square l'ootage"may lie substatacd for kital Project Cost"
ENNNNN
■■■■On N■N■■N®■■■■■■
FAM"WAORKA Mid
■■■■
INS■■�■■nN■■■e 0"Wo Afoul
mir
EMENEVIor
■
N■�'� � ' �.�'��■�■■IN■■1■ ■■■■mil■■®®
B 4 a d ■I■NN■N■ NEW, `I■■®■n■
IC' '.m 7►Lii� / "o i. m '■NtWNNR'■EIINN
151
AN MEEMPERI
WPPWO
, rrr_r�� �,,�iv� �iir���NT1117i®®�/%o�l■�N►
I �r�w�e� wn v®I =RS ON
® ' Sri
NO 1164.1 ltiopdpw-pompmmmmm Or
■■■N■n®® ■_■ms`�!�N■■■■■ ■■No 0
in� n,i
v�■■ �►b_iVA. �d1l;�L�®■■N■ ®■■N■■®�
N■n■■■■■ Ns■■
■■ni■�■■i,�rni� ■■rr�r
■■■ram ® v
�� _ _�rr■■�.■
PIN
NEI
I:���■■■�p�s■■■I I�■■■�■tea■��■■�■1
■■■■■B■■■■■illl■■■■■■IS I
Mill
■■■■■■1
■ii■nv■�Ili■■�il�■�i■■�■■®
■■■■■■■■■ ■■■■■■■■■
MIME MOMMIMEW11
on&9= N�mm - - -- mmm
s
n� / ■ 0 ME Em I mm
■1 M I■■'1■■■��■■0 MI■■IMMINIM
■■■■■■■■■
®■■tl■I■1■■■®NUMMI■■l■ ■■
Mir R=®®ElmI■1■■■ 1■�■■■I 1
���0n�
■
■
! LJ
!-- I - !,
ut V17 I
I
f I I-
!
i i I I II I ! I � �IITYIi !
il ! I � I I I I II il ' il
! / !
1�
v �■■
No� ■■ %, a/�■,®��� ® 1■■ � � , 1 ;
■ ► ► � �■■■.-gill
ME
R MEN
Illial.
0. ■ .�. .i ■ ■0■■ ■
■■ � ■ ■E■■E■S■■1 IN Is mom
1 ■ — ■■■ ■■ ■!\� l
imimmmo MEN
�I®���■■I■■.
��•��••••■■��••�•■■■III■�■�■�■■N 1�,
�. fill ■■■■■ 11i ■o�ioi
I■■■■■■■■■■■■■mil��■■ ■■■■■��
N� '� �r��■■■■mil®■■■■■■■■■;
Mill I ! !
ICI i ! i
I
I I i
1 All
I_
I
Ili ' I III III IJ I ! IIi' iiIIIiil '
' ! I ' I II IIIIIIII iili �Ils
A. IIIIII
IiiI I
1 I I I I
I i I I a I I I i I
_IiIIIIIiIII III �T 1 � 11: II � � illi ! I!il ! I
IIIllilliljl 11 II it '� '� i � I � Illlii '�I_
III II IiIlllill ! ! , ! I I- �_- IiIII ! �-
i
! II III II I i II I �
! riI Q ! !
1 ! 1
/IV 1I � il II II iII II
-
�I
/,-f 71 7
i
Ili I III III I � I, Illljll ! !
l l LI
DEED REFERENCE:
BOOK 19310 PAGE 69
ZONING DISTRICT - R1
N/F
WILLIAM J. &
CONSTANCE J. KIRBY
PARCEL ID 09-0236-0
41 SABLE ROAD
p"W
N6p222 '
.1
SNF'�
LOT 234
119 000± SF
N/F
DEIULIS BROTHERS
CONSTRUCTION COMPANY
PARCEL ID 09-0255-0 PROPOSED
40 CIRCLE HILL ROAD ADDITION
20' X 20'
ui
_ oII
M N
N 26'f ^ 0
rn
.0' 30•f �
REMOVE RICHARD F. S KOWICH, JR. &
EXISTING JULIE M. SAKOWICH
/ SUNROOM PARCEL ID 09-0231-0
/ 36 CIRCLE HILL ROAD
SPLIT ENTRY
o WOOD FRAME
U
V —_
m 19.2'
N
I
N 7)74 �.
\lob w
�8 ni R 00 00
� NlL L ROAD
"I CERTIFY THAT THE DWELLING
IS LOCATED ON THE GROUND AS
SHOWN HEREON. THIS PLAN WAS
PREPARED FROM A TAPE SURVEY." SALE M , MAS SAC H U S ETTS
a_j PLAN OF LAND PREPARED FOR:
RALPH W, REID P.L.S.
SCOTT F. FOURNIER
�RALYAq�c 38 CIRCLE HILL ROAD
WII�IpAHMI
No. 29422 - PARCEL ID 09 -0230-0
FE w s � 'Z REID LAND SURVEYORS R
�] 365 CHATHAM STREET
LYNN, MASSACHUSETTS
R12-013
RWR DATE' MARCH 5, 2012 SCALE: 1 " = 20'