25 CLEVELAND RD - BUILDING PERMIT APP (003) R
y ,
,' � The Commonwealth of Massachusetts
Baurd of Butldtng',Reguluuans and Standards I'OR
a � MUNIC'IP\l f I1
Massachusetts State Bufldmg Code 790 CMR 7 cdtuan UhE
it
Building Permit"Application Ta Construct, Reprtr,;Renovure Or Demolish u( Ru ia<•d Januur) "
One=orTyo,Fninily'Dwrlling %'
- This Section ForOfficiul Use;Only
I uildmg Permit Num r� Dme Applied:
Signature
• ; " Boitdmg Cummission<d - torol Buildnigs , ` •Date. ?`
SECTIOIY-liS1TE'.INF,ORMATION
'1;1 Property:Addr s9 12'Assessors Map& Parcel Nmnbcrs
Z 5i t �r cl¢e7 `JAB :�)A 1D
luau is this tin accepted street f yes'_ .Map Number, Pan.<I Numh<r
fi3 Zoning Infos*n 01i 1.4i Property Dimensions
"Zoning Dottie[` Proposed Use„ ( - Lot'Areu(sq R)':,` Frantuge(i[)
1:5,Building:Setbacks(ft)
"Front Yard Side'Yards Rear Yard
Required - Piovrded Required' 1?rovided ";Regwred _ PmGulad
A 6 Water Supply (M.G:L c.40,§541: 17 Flood Zone Information 1.S Sewage Disposal Sys term
- Zone OuL?idr Flood Zone7;, Municipnl❑ On arie disposal syptem ❑
Public❑ --pnvate❑ , " •• ` _,.,.Checkif. esQ
_.. : .. .
y i
SECTION 2d PROPERTY OWNERSMP.� /
Z.1 Owpf �o[Rerord AAe�i h14 ' ff!`/d
u �
Nome(Pn� Address Far Service '
'S F. Tet''P66he .
} . SECTION 3i DESCRIPTION`;OF PROPOSED WORK=(check,ull that apply)
New Constiuctian❑ Exi'shng Building❑ Owner Oi.wpied ❑ Repoirs(s) ❑ sAlterutiori(s) ❑ Adduum ❑
Demoh[mn •❑ Accessory Bldg ❑ Nur tber of Units .Other Sps"
Hnef Description of Proposed Work:
SECTION 4 ESTIMATED CONSTRUCTION COSTS,
ten" Estimated Costs: Oftieial"Use Onl
(Labor and Mal ermis) y
'gl 1'rButlding !$ L Building Permtf Fee $ Indic¢te how fee is determined
- � ❑Standard Cr[y/Cown Application Fee
2.Electncnl $ ❑Total Protect Cost'(hem 6)x mulnpiler x
3.Plumbmg : , :-$ Other Fees $ j� S
4.Mechanicnl,(HVAC) ;$ List [J
5.Mech¢nical (Fire $ Tata1 All Fees $
Sti cession)
•• Check No. Cheek Amount•= Cush Amount;_
6.Total Project Cost `$ ��p,'.pp ❑p¢id•in Full •: "t3 Outsmtiding•Bulunce Due
r -
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on-S "WU
SECTIONS CONSTRUCTION SERVICES ;
I uplary ts
Construction
Number Expiniuun Dina
"MY
Address °
_4
-.T
W,
lust dlauun
I il;A fD Residentiul DeIjj()jjjjbn
'
Hl : 0 a=Company JCL R bunt Name ta Registmin umbe
fir L'
ate.;--
S Telephone'
nIM ignQ
�rL SECTION 6 WORKERS';COMPENSATION INSURANCE AFFIDAYiT(M G[ c 2 5
ffl U
ItSttrilpCe:
m the-d nid
Mork drnpenstitIdW
ii ift Vic flUrestqr'
L SIECTIONMW OWNER AUTHORIZATION,
G ENT ORr.."Cr 0
f 6�hcij,�o r the isubject property;hereby
,;i-;�,,
ton MYL e
6 In all muttersrelnnvet wo c authorized by this building permit appbcnbon r `
:I `c �. � �:� �� has Owner or Authonzed�Agent hereby declare `'
fgr
thauthe statements and on on' e oregoi app catat 00
true and accurate t the best of my knpwledge and
behalf Pant Name - lit L.,
-'j'7
L� '
t
th D
Si d Agent
ribidiiii orNOTES v
!q 'g
aie
P
- o- 1�.or an owner who-hir6j;an unregistere contra,A :.low 9 Ff:?wqrj,�voF d cl r.
n wner,w o ob A�building,peftfilt
contikRIiiAftcRioit�),Ti�ilwldrhdvi&t eSSrtothe a rib itc a thin
AnIMMonne: morbVerni
(not registered
r guar,ant ffin&bndeiM-
, 14M OtHO rtaht'ihfdrmiibh,66ithe H[C Progra
m:u
Y.` Construction Sdpc"Isor c n#�CSL can be uIlO.CNW-Rep!atow res' c V
2 When
yubsmnual;Work is plannedid ihi:infdftriiition
jbLIIj
finished bascinii S�: eC, yr
;Total Mors:area (including
-:Gross Irvin- area
S,
Number r 5
;.Type of heanng system Number of decks/pnrahes
Enclosed;Type of cooling system! en,
7777
tAu Project
Cost
7