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18 GABLES CIR - BUILDING INSPECTION The Commonwealth of Massachusetts ' Board of Building Regulations and Standards FOR. JTY Massachusetts State'Building Code,780 CMR, 7`b edition MLJNIUSE. �!' . Building Permit Application To Construct,Repair,Renovate Or Demolish a' RevfsedJanuary. " One-or No-Family Dwelling 7, 2008 This-Sead m For Official Use Only, . . Building P ennit Num Date Applied. Signature: ` 2 BwldingCommissimm-/Irup=wrofBuildinp Date _ SECTION 1:'SITE INFORMATION 1.1 Property A dress: 1.2 Assessors Map &Parcel Nubers t� �� C' m r . lo : 0a33 1.1 a Is this an accepted street?Yes_ no Map Number - Parcel Number. 1.3 Zoni Information:., 1.4 Property Dimensions: ` Zoning District - Propos Lot Arta(sq it) -. Frontage(Ii) 1.5 Building Setbacks (ft). Front Yard Side Yards _ Rtar Yard' -- Required Provided Required Provided Required - Provided L6 Water.Supply: (.KG.L c 40, §54) 1.7'Flood Zone Information:... 1.8 Sewage Disposal.System- :-.-- - Zonc Outside Flood Zouc? Public❑' Private El — Municipal❑ Dn site disposal system 11 - Checkify es� . SECTION 2c PROPERT- V O��rI�EiLS13IP' Z OwnertofRecord- �.��., S,� 1g Name(Print) Address for Service: 3c94 Signature .. - Telephone - .. . SECTION 3zDESCRIPTION OF PROPOSED WORK- check all that,apply) _ idg n.:h SeV. Gon=-- 'on ❑ s:inp. . • ' 3i, Demolitind ❑ •Accessnry Bldg. ❑ Number off(nits_ Other 1pccifj:_ Brief Dascriotion of Proposed Work'': C W ' VI 'b S + f,,i C Tru' ^r r SECTION 4: ESTIMATED CONSTRUCTION COSTS Estimated Costs: Item Official Use Only . (Labor and Materials i.Building $ o 1. Building Permit Fee:S Indicate how fee is determined: 2 Electrical $.. ❑Standard City/Town Application Fee Q Total Pro7ec Cos? CZtem�x multiPBar x . 3.Plumbina $ 2. Other Fees: 4.Mechanical C)-1VAC) $ List S.Mechanical. (Fire $ Supprtssion) Total All Fees: $. Check No. Check Amount: Cash Amount. 6,Total Pro)ject Cost: $. da � �t �� ( 0 Paid in Full ❑ Outstanding Balance Due: SECTIONS: CONSTRUCWN SER G S 5_1 Licensed Construction Supervisor(CSL) . .. . 1 11ea tA"Ar)A - �UcenseNurnbcr :ExpuutionDate. Name of CSL-Holder Ljl)v-t- c`�e lIstCSLType(seebelow) Address T P=crrprion .. U Unrestricted( ' -to 35,000 Cu.FL Signartwe - - - .. R Restricted 1&3 Family Dwelling ,. . 3''3J 4' cil�(Jl� TvI Mas Onl RC Residential RoDEn Covetin Telephone. X Ssc3 e' _ WS- Residential Window and Sidm . - - _ • SF Residential 601id Fucl Buming Appliance Installation . D .Residential Daaolition - - - 5 Registered time I rov went Contractor(HIC)' l r e 14-681 � HIC CpmpanyName or 1C Reg fstrant N Registration Number . ��"� � or-� h�ry ✓k�Ad wExpiration Daze Telephone . . _ SECTION 6:WO RS' COIYi3ENSA1-ION DISURANCE AFFMAVIT('M.G-L.c:132_§ 25C(6)) '. Workers Compensation Insurance affidavit must be completed and submitted with this application: Failure to provide . -this affidavit will result in the denial of the Issuance of the building permit Signed Affidavit Attacbcd? Yes :-----.:..Br No..........❑ SECTipN 7a:O�' ypTION TO$E•COMPS ETFII3ytT:. ©�i NER'S AGENT 3A-"CONTRA C7'UR APPLIES FOR8I3II iii N PS}IL11�T as Owner of the subject property hereby author e r i trio On p a/AU y:1- . to act on my bebal in all matters relative to work authorized by this buildirig P PP permit application. Sr aYure of Owner . - .. Dare SECTL01 �6t=DY+I3Ek' OR AII��RSA1AA� Z� OTtf '. .-° .� : .}:. ���:U•-� 11P c� '�'i�C}y� ,a_S-Chvnet~pr�UthorizedAg�ntlierL$y'3e415tC' �• that the Katestrils and information'mri the.for>_eeing'applicatiuu azefro�:.ai3d accitrai'z,.to[lie best of niy_ktimA*8gc�a--8 - belWL .Print Name Signature of Owns or kuUid—rized Agen[ . Date _ (Si ed underthc pains and pcnaltics of - .. - . . NOTES: 1. An Owner who obtains a building-permit to do hislber own work,or an owner who hires'an unregistered contractor (not registered in the Home Improvement Contractor Imp (HIC)Program),will not liave access to the.arbitration program mr guaranty find under M-G-L.a..142A-Other important information on the HIC Program and - Construction Supervisor Licensing(CSL) can be found in 780`C R Regulations 110R6 and 110.R5,respectively. 2 When substantial work is planned,provide the information below Total floors area(Sq.FL). (including garage,finished basement/attics, decks or porch) Gross living*Brea(Sq.Ft.) Habitable room count Number of 5replaees Number ofbedmoms Number of bathrooms Number ofhaMaths Type of heating system Number of decks/porches. Type of cooling system - Enclosed Open - - — 3. Total)tnjectSqu uz Footage"may be substituted for"Total Project Cost $ � - -- -