25 DUNLAP ST - BUILDING INSPECTION JACKET —. T— -- -- -
------ nc� (l_nnnnnnseaIth of \1aSsc ahuSCI t( ilt
t` Bodid of Building Reculaions and Standards
l �~ \lnsaaehusetts State Building (lode. 780('MR. 7°' edition I I til
Fuilding lienni( :\pplication TO ('tmS(r(tet. Repair. Rent,%ate (h Dellitrlish .t
tore'•- r„ r,i rr-i r,,,t;r, n,i t M,t(,
`1C his .Section For Ottic ial t lse (hdy
Building PCI'mlt Nun .er _—_---_— Dale Applied:
Si^_nature -
Bwl mf Cumnu..uniev to j e.wr of Rui a .. U.tle p'
SECTION I: SITE LNFOR\I:\ HON
fjt.I Pr(o•�uert1 .'\d_drne+s: o I I.'_ 1Sseuun flap .'E Parcel Nuutbers
( Ma ssunihcr I'.u.al ?lwnhci
I Lt is this .ut all•pled 'tree' ' sex____ nrr—__ P --i
1.3 Zoning Information.: 1.4 Property Dimensions:
�,.,,,,:E Do.nc'.�^^•.w_ Parpu d( Lu l: Ca I7umaizC It, '
1.5 Building Setbacks (ft)
j Frun( Yard Side Yards Rear Y and _.
t Reyun.-d Providcd Regfflued Prtn ided RcyuueJ 1, 1
L
I
L6 Water Supply: i�1 O L e 40. §54) 1.7 Flood Zone Information: t%1.1un,`,k�pI
.8 rwagr t3isposal 5ystenc
- -- Zone _ Outside Flrwd Zone'.
Public G Pncate Cl Check it yes❑ ❑ On ate disl>,rsal sYacin ❑
I` SECTION 2: PROPERTY OWNERSHIP'
2.i Owner'of Record:
F IA n vb i e _ -- — --
Haute 'Pnnt� Address Six Service.
� Sipnalurc rclephune
SECTION 3: DESCRIPTION OF PROPOSED WORK'(check all that aPply)
^iew Cunstrur!ion ❑ Existing Bw Wutg ❑ Owner-Occupied ❑ Repaint�! ❑ :\Ilt,r.i!_ml�J ❑ \dd;t'm El
Demolition ❑ Accessory' Bldg. O Numher of Units__ Other ❑ Speeuy_.._
Beet Deseriphun tit Proposed WorkJ:
SECTION J: ESTEMATED CONSTRUCTION COSTS
Iteem--------- Esumated Crests: Official Use Only
i Labor and Materials'
I BuJdin¢ 5 I 1. Building Permit Fee S"__— Indicate hint tee n dCtei uuncd.
❑ Standard City/Town Application Pee
2 Electrical 5 ❑Total Project Cost' I Item GJ x multiplier __ x
1. Plumbing 5 I 2. Other Fees: S
4. Mechanical IH\':\CI It -- --� List:
5 Mechanical &"': $ _
Su ,Ire
sauni Intal :\II Fres: 5
i..— _-- � 1'heck No __-Check Ain,u tit _.._"_--( '.nh Vuotuii
/b final Project Cost 's 3 0 PalJ in Full 0 (lulstandittg Bal.inie Due-_._--. _
SEC"TION 5: CONSTRIL C I'ION SER% ICES
Rt. I,k' lival Hoi'l:!1v
:J"11 'I'd
5.2 Registered Iforne Improvement Contractor (111C)
0.'le
I g!I a I Ur e le
I— SECTION 6: WORKERS' COMPENSATION INSURANCE AFFIDAVIT M.G.L. c. 152. 5 2506))
Workers Compensation Insurance affidavit must be c,,mpletedand suhnimed with this ipplicao-ai F,iltiic to lit...I'le
this atfidavit will result in the denial tit the Issuance of the building permit.
Signed AttidLo,it Attached Yes .... .. . 0 'so ' . 0
SECTION 7a: OWNER AUTHORIZATION TO BE COMPLETED WHEN
OWNER'S AGENT OR CONTRACTOR APPLIES FOR BUILDING PERMIT
as Owner tit ththei(lm,peN hereby
I akithiinze to act i,II in, it; itl liallels
to •.work authorized by this building permit application.
�—ileoUIUWOI 0,,,ner— Date
SECTION 7b: O"NFR' OR AUTHORIZED AGENT DECLARATION
1. as Owner or Authorized lipent hereby declare
that the statements and information on the foregoinc :application are true and aCLUIAe, it, the best tit my know iedgeand
h alt.
rP'--.t Name
/< 40 v
Sod'llatUreof Owner or Atithm i/eclAgent Date
i Signed under i be pains and penal I tes of perjury,
NOTES:
I. An Owner who obtains a building permit it,do his/her own work. or an,mrier %,,h(, hires all UnIeLlIlLId
(not registered in the Ifortie Impno,ement Umilractor Mff-') Pn,gjamI, will it,)( hj,tLavers It, the aihittati,,n
program or guaranty fund under M.G.T. c. 142A. Other important information nit the I IK' Pr,,�,iain and
C0nsIlUcIl.)n Supervisor Licensing WSL) can he hound in 780 C%IR Regulations I If) RO :md 1 11) RS,
When uhtanital work is planned, pros ide the intormation below.
1,ndl t1,wrsaFCU I Sy. Fl.I i inc tuding garage. flinched ba,clIMIUMI 11 S. 1ICL k1 I ir pin.hi
(;o,,, Io.,n1y area iSq Fr.) H.thi I able ii,,mi chum
Number ,f tit eplaces Number i,I bcdr,i,-in, --- --- -
N,jinhct of haihio,-nis NainhQrol h.dt hj!h,
I we it heatoltz, s,lem .... Nurnberot to,k- p,r bc,
he i it,, \ tern Ii n,h 'cd
1,10le,I Ci.'l