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3 ELEANOR RD - BUILDING PERMIT APP the Commonwealth of MassachusettsCITY - U/I Board of Building Regulations and Standards SAL OF SAL OF Massachusetts State Building Code, 780 CMR Rerlced,t/ar20/1 yW Building Permit Application To Construct, Repair. Renovate Or Demolish a ne- )r Two-Fumily Dwellb Th s Section For Offi Use Onl Building Permit Number. le Applied: � � O Building 011icial(Print Ntune) Signature / Date S CTION 1:SITE INFORNIATIO 1.1 Property Address: 1.2 Assessors Ma & Parcel Numbers 3 EL rt L la Is this an accepted site . yes no Map Number Parcel Number 1.3 Zoning Information: 1.4 Property Dimensions: Zoning District Proposed Llse Lot Area(sq It) Frontage(11) 1.5 Building Setbacks(ft) 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: Zone: _ Outside Flood Zone? Municipal ❑ On site disposal s stem ❑ Public❑ Private❑ Check if yes❑ P P y SECTION 2: PROPERTY OWNERSHIP' 1 Owner'of Record: f}rit�S Kvyr D t ) (_eS s A—Lr-rrl jnR-- 4n�j r9 C© Nant (Print) City,State,ZIP 3 EL>`�tibR cP/ yt�So Nu.and Street Telephone Email Address SECTION 3: DESCRIPTION OF PROPOSED WORK (check all that apply) New Construction❑ Existing Building❑ 1 Owner-Occupied Repairs(s) ❑ Alteration(s) ❑ Addition ❑ Demolition ❑ Accessory Bldg.❑ Number of Units Other ❑ Specii'y: Brief Description of Proposed Work-: SECTION 4: ESTIMATED CONSTRUCTION COSTS Item Estimated Costs: Official Use Only (Labor and %laterials) I. Building $ ` U 1. Building Permit Fee: S Indicate how fee is determined: ❑Standard City/Town Application Fee _. Electrical S ❑Total Project Cost'(Item 6)x multiplier x i. Plumbing S 2. Other Fees: S 4. Mechanical 01V:\C) S Lisl: i. Mechanical (Fire S Suppression) .total :111 Fees: $ --- !W C'hcckN0. Check:\nxmnt: _ C;uh :\momri:v 6. Total Project Cost: S 7� 7 ❑ paid in Full ❑Outstanding Balance Due: -- 2(0�7 Y SECTION 5: CONSTRUCTION SERVICES 5.1 Construction Supervisor License(CSL) � 000 - 41—_fin/2 1_ Fl2C� _ l L L(`� License Number Ifcpir;aion Date Ntnle ol'C'SL. I lulder "rMICT,0 0 Zt 3 L�.S— 3�( Liu CSL fypn(scc belott) / � IlE _ No, and Street Ty Pe Description /.9OL� LI Ilnrestricted(13uildin�st1 w-000 Cu. It.) Cifell—u�vn, Slate,Z-1P—�_ R Restricted IK2 Pamil Dwcllin� M Mason RC Roolin'C'ovcrin WS Window and.Sidon SF Solid Fuel Burning Appliances W H� _ I Insulation "fete hone Email address D Demolition 5.2 Registered Home lmproventent Contractor(HIC) AktRE-p 75?- / 0 ( I IIC Company Nance or HIC Registrant Name' ,y I IIC Registration Number Expiration Date CCU�l Ix L� P�r�E- /AD,4"f c-b No,and Strecl filLG ".er�e�( /� (�� 7C6� 'r/_ Email address City/Town, State,ZIP // �YYI� O U Telc hone Y SECTION 6:WORKERS'COMPENSATIO"SURANCE AFFIDAVIT(M.G.L.c. 152.§ 25C(6)) Workers Compensation Insurance affidavit must be completed and submitted with this application. Failure to provide this affidavit will result in the denial of the Issuance of the building permit. Signed Affidavit Attached? Yes .......... ❑ No...........❑ SECTION 7s: OWNER AUTHORIZATION TO BE COMPLETED WHEN OWNER'S AGENT OR CONTRACTOR APPLIES FOR BUILDING PERMIT 1, as Owner of the subject property,hereby authorize to act on my behalf,in all matters relative to work authorized by this building permit application. 9MES �yDtfro �lL-yS f_ /(,— I I (/ Print Owners Name(Electrum`,Signature) Date SECTION 7b: OWNEW OR AUTHORIZED AGENT DECLARATION By entering my name below, 1 hereby attest under the pains and penalties of perjury that all of the information cot rained in this application i tr a an ccurate to the best of my knowledge and understanding. co 70 =1, E p r��tZ s Print or Auther ,\gwt's Name(Elecuonic Signature) t/ato NOTES: I. An Owner who obtains a building permit to do his/her own work,or an owner who hires an unregistered contractor (not registered in the Home Improvement Contractor(HIC)Program), will not have access to the arbitration program or guaranty fund under%I.G.L.c. 142A. Other important information on the HIC Program can be found at -;o%nc:1 Information on the Construction Supervisor License can be found at\tit iot ,Iltj ? When substantial work is planned, provide the information below: Total floor area(sq. A-)---_(including garage, finished basentent'attics,decks or porch) Gross living area(sq. 11.) _ Habitable room count Numberoffireplaces-___--_----_ N'umberofbedrooms -- --------- Numberof m bathroos _--.--- Number of half baths ----------------- 1)pe of heating system ` --------.__--_ -- Numberofdecks, porches_ I')PC ofcouling system � ---------- ?. "fond Project Square Footage"stay be substitulad lbr"Told Project Cost"