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15 DALTON PARKWAY - BUILDING PERMIT APP � The Cantmofcwoaith of IYinss.tchtt�tts E nR - ` 8onrd,of$ntidtng Rcgntuuans and Sttiadurds ; lVdassachusetts Serte Buiidtng Code JoiP CfoPr4 7n'edatt an Tv9Jh�C]t,\t I t a' use ,.: ,. ..,�ut0dtng;E'erattt Applp'cutaon T®�aa(st[t5a:i ,Retract' DB�noti.tke t3r:t)ernnEtsh:a Rr+tstrt Jnrnr+rrt Onp orTsloFrrnulv,t3xr11efrg 'rNd3 � =w ": 'Cktts3eitaaatForQfi`fnntUse_Oraly _ i;wldtag Petmlt Nu hef_ E3nte Applied_: r sggwturc G rJ' In uratttirsswnerl Inspec of Nulldanes oste 5@CTION 1 SlTKjNFORM*TTON RAW I I opeety,/ d r�ss 1: 12 Assessats'Cvlup&I'a`rcel l�awattefs S;tu Bs this ur9 tcdepted Beet?yes' '_ na M Number.' Pgtcrt Numh r 1'3 Zaning InformntCoa I.4 Ptnperky Difnetrs0ots Zonfng Dtstrkt Prugesed Use'�; >t.W Atar!s4 tD'D- - Frontage Ilr) ,', - yY� 03st00dltc�"5et�ecbsi;:(I4) � a Srde`Yo.... rYmrd .:: ,... , ,- ,.. '��Reyulre+E Provided Rtquired P^avuled - .' :Retlurted Prcrwd�d I s _ Ilia Wakef Sipp0y iM.G,0.a k0 §Sdy 17 Flav,417�aree Iyiteirrxnmtiaru T I.g$ewnge Dts-pusml$ystear. , - " 7�natstdeFimmdZane2` M,. isitedis unlc0 alO t3r snls Breen f] Public G'! ��Pnvnte❑ " .,; .. p !p Y : SECTIOIY`Z: 'PR®PE$TYQIWiYER3fItPt"`.: .t. Name(Prdntp Address rVmce , s zl do ' Szgnature ; � - .. Tetephone., . tsECTRON 3 DFSCRIPOIOAi OF PRO OSI3D WQRK�(cheeis a0!that npplYD „ , ;: New Cansttuctlan[] irsnng Suit i0ng❑'' Ouaer ticcujs0ed ❑ .It,P(361rsfs) , Alteruven(s) ❑, 'A ldntan ❑ posts ki t7etpoltt{on, ', ❑ Agcess�y flldg ❑ ,, Number of Units %;Other '1],Spenly - - , IirtuIA f scriptiaa of Pro used ark'o' 6 i WASct NQ�/ SRC3I43PI d .ETT751. �R'S fC[63 I ION C Etem Fstlmsted Costae Offlclnl;tPse Only tGnbarnndIvInterialsj' L.Butt din g S ;pp P Bwldrilg Per»tt Fee $ tfuitaate huw fae rs deterauned 2.60ec[nenl S ❑Starldtvd CetylC®wsrAppttc+lEon FROM ee ' LI Totmt Project Cosh.(item 5)x mulaptler 3 POttmbtng S r Otfler Fees $ ygg� ATE, Of d '1Hechaarcat lKYAC7 $ List t / antst 5:Iv0., hanu:t3 `{Fire t tslow Su mny $ Taud A(I.ees . spun Check Nq: CElet k Amaunt 0.Ish Amount 5 'i'otal P%yeet Cock -.. 1! Q Pmtd In FYL u16 ,' Q Oatstaadmg 03Slaisce'Due. , :�. i « SECTYON 9 CbNSThUGT1 ON 5ERVlCES S d Licensed CotvStrnctloe So rwisor(CSL3 ' a -- .�- � EastGSLTYPatsee)ielaw) E r R Reatncted i&'SFuOuI :Dw'etisn ' - . t + 1 = RC" : `Res3dE11[i$t RanOnu-CYfYcrmg + •v h r Telepham WS :- R�xttiiniiut Windutv,!undSulu+. .' - - `'' ASF=`�-" Re3tilutUiilSultil.FOCI'Bumtn 'A "h.unt`latitul]ti+ut o red. D Restduuial DeawLuan t 7- / mq YO S f -: HFC N w tC t Nwac Regis tionNtuahet .. . Address .' .'. - o��Q, 3 .� - Ezptratttm Date Stgnaure::: - Teleptttu+e + - ' � r, &EC'I`!ON b FWIDRKERS`COMFENSA'1'ION:IPTS[JR/►1VGE A1<FIDAY['P fiYi G.L.c.152.$Z�C{633 ,,' workers Gompcnsn?tan L>sntanec"afft�aVtt siust 6c completedMA", wieh this nppltcauua 1 attune to pray de thtsufftdtiVit a tliryresult to the di titai of the lssuatice o�llie tntafdiag:perratc u Stgred' ffidnvrtAtiuched? `es Ell SECTiflNTa OWNERAUTHORIzATdONTOBB t1MPL-dETE1?WAENI u OWNER'S AGEtVT'OIR CONTRACTOR [I'S FtBR 8UII DING { r z asOwoerofthesub7ectprdjk"., hereby,' atnhanze —, to act an my bohalf to all m.ihena �; relapvetuwnrkaur}torrzedbythisbufidtngpermt[nppltca4on. f - � r si awrentOwntx. . - _3 — -Date _ i n ,,,.:,., :'SEC*t7ON=7b OW1V�RtORAl7'f'HQRIZLDAGENT,-DECLARATION - t - I „ as Ownrt ar AUthonaed Agent lseseby deo.lum thafthestatemants amI tnfortaatcan-on the fhregotng appEicatitsa`are true and ncc'tiratis to the,l;est of mY fnowtedge and tmhatf 1 Frint Namez Stgnena'e of 6wtux ttr ALthtutzed AErnt Gate (St "` :uriderthe`'eins`�d`.. •altiesof 7 .- k. , .-.:.t `;. 4 ; lAn QFWrtet who obW, n 6tuiditig pemut to do hset — own work,or m owaer who titres an unregsteted vontnn wr �ticit refits Bred 7n tltp Rome Ituprovemcnt Contrat'tot(HIC}Fragfnm) will da have¢cress to file ur6lunutt� '' N; � {program ar gnaranty,fuad ttaiier�IyY G.L.r: I42A:Ot3rarrmportant tnforntetioit on the HiC Frogrorn ntai . - CnnswcdoaSsspervfror Licanssog{CSL),`c5a Rg foticid Ia 7R6 CIaIR Rngulntinns 3!0 R6 astd l ID R5:rpecnvely 3 whdhzsttbamt Wfrw,rk tit planned Orb ide the iafnrtaati9n betOW: a , Ttttal flooes wren{Sij _kY) `' (mctndtng-garage fintsiicd bttsemet%Jatbcs de�.ks ur purt.hl Gross)turn area{ Ft} Flii6ttable room utttnt ' g s9. N+Imber offirepk+ces Nu'mif&of bddrooms Numher of basFrooms. t�Timber of ha3flbaths 'Type ofheaungsystean '_�,_" lYiimba n#dtxksl7atrchts° '' Type of caolmg system Ertckued Open 3 Tatal,Fm ect care Foote '^may Wylie sabsttittted fm 4 i ofal Fraject Cass r T o 4 q -