15 DALTON PARKWAY - BUILDING PERMIT APP � The Cantmofcwoaith of IYinss.tchtt�tts E nR -
` 8onrd,of$ntidtng Rcgntuuans and Sttiadurds ;
lVdassachusetts Serte Buiidtng Code JoiP CfoPr4 7n'edatt an Tv9Jh�C]t,\t I t a'
use
,.: ,. ..,�ut0dtng;E'erattt Applp'cutaon T®�aa(st[t5a:i ,Retract' DB�noti.tke t3r:t)ernnEtsh:a Rr+tstrt Jnrnr+rrt
Onp orTsloFrrnulv,t3xr11efrg 'rNd3
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_ i;wldtag Petmlt Nu hef_ E3nte Applied_: r
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In uratttirsswnerl Inspec of Nulldanes oste
5@CTION 1 SlTKjNFORM*TTON
RAW
I I opeety,/ d r�ss 1: 12 Assessats'Cvlup&I'a`rcel l�awattefs
S;tu Bs this ur9 tcdepted Beet?yes' '_ na M Number.' Pgtcrt Numh r
1'3 Zaning InformntCoa I.4 Ptnperky Difnetrs0ots
Zonfng Dtstrkt Prugesed Use'�; >t.W Atar!s4 tD'D- - Frontage Ilr) ,', -
yY� 03st00dltc�"5et�ecbsi;:(I4) � a
Srde`Yo.... rYmrd
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,- ,.. '��Reyulre+E Provided Rtquired P^avuled - .' :Retlurted Prcrwd�d
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Ilia Wakef Sipp0y iM.G,0.a k0 §Sdy 17 Flav,417�aree Iyiteirrxnmtiaru T I.g$ewnge Dts-pusml$ystear. , -
" 7�natstdeFimmdZane2` M,. isitedis unlc0 alO t3r snls Breen f]
Public G'! ��Pnvnte❑ " .,; .. p !p Y
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SECTIOIY`Z: 'PR®PE$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
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