28 GABLES CIR - BUILDING PERMIT APP (002) f
fhe (',m mow.%callh I)I NIJS.aehuulls --
t Bojid of Hulldinc Reeulauun, and Slandaid, t
�,�, I \II `Il II' AI I I 1
Slab Iluilding ('ode. 7SO( MR. : idiu„n
!3,uldin_ I'se mil Appliralion TO ('on>Inlcl. Retrain. Rcol (h Dinlr,li.h ,I Its,
Urrr" ris hw- fiv
I'his Se on For 01fi Ial I'.e UnIV
13wldu.e Penml Number 1--A Ill e . ) Ied
Bit[I'll nF C'ni r n.....i nu lII icIor is IIIII me U.ui
SE("1'ION I: . IT INFORMA I ION
1.1nPropern Ad/dress: 1.2 \sseesnn Map S. Panel .Numbers
F .n..l \u - _
I la. Is thu an e \laP\,.mhir mhn
CreprcJ elricl scs. . ... nu—___
l i.3 Zoning Information: - 1.4 Property Dinwn.%iuns: j
I
[„nut¢ D•stt,rt _. Pr:::e .,. ( ... _. � I : rrc.. ..( i,i }1-,:.: n i
r ,..ill -'iha' -S tFti • - r__ - i
Fr; nt `t rJ .T ...._ Side Yerdv _ Real \:nd
I___ ku{uu 1 _ Pro'.eliJ —+ _Rcgw:•J Prol!Jid Requited I': n_d'U—
1.7 Flood Zone Infatrnatton: 11.8 Sewage Dt posal Sy,tcor
Zone- Outside f lit,d GMe.,
Puhlic U I'n vale❑ — I .Numap9 ❑ On it wepo r ❑
_...._ Cheek It ❑
SECTION 2: 1111OPERTY OWNERSHIP'2.1 Owe'er'of Re ord: C/�
�unc�b� -- - -- -- - -
i
1.it I'll) AJdn_.. or Nei ,ie:
tii�n:':urc 7olipmmc i
j SEC` ;W' .1: DESCRIPTiON OF PROPOSED WORK Z(check all that ni:i.lyr
.ve,v (' r ,- ;.,,�t � I r. .,:rr LuddingO .1.(J:•.nr_r r-ur pr�.i :7 I R, .n(a1 ❑ J It- r-.n,�il., ❑ i
I�. n: rc!• I . e I s rikfg
// un n r ,. Uri' 1 Ot'•.s_❑ s r 15
,ir -_fIi r..r... t , . I).,;,c• Yi, rv." -(,.�n r 1�- X 40 _ �Lr
_m ! Off;cial Use Only
eo b o ' Building P nu F indicate It e Tie is, dkoiCr mini J.
--- ---- �-----i ❑ Standard C I s!!, ' ti Ar-phrabrm lee
I Ircl realS -
--- ❑ -final Pr gecl (',,.( r,rom) G) r multiplier _— r
a Plunthu)u O(her Fee,. ll
--
1 Me,:h::nr_JI ill\ At. l r5 j_ I tit -- -- ---- _ --- --- - -----
's'l isinr , f IJ All Fees
:— heck No _ ( hc•,.l. .A!ll"unr' ( .,.h Am•urll
b Total Project (.nst S 3 Paid In Full ❑ (hn>tanding Fi.Il.rn.e Uui
SECTION 5: CONSTRUCTION SERVICES
s —
. .1 Licensed C'unstructiun Suprrsisor iC'SI.1 -- /`�3�� o
_���c.•�-_ ��/�/(��f/��f Ll.i n,r .\ulnhar I.,Iln.lh<�n I II:
I \arii ��I ('S1. IhdJir Ln1 51. 1\pt „ee hi lnwl
/n'/f l 1 ❑Ii,IIIJeJ ni � In •`.1 MIII lL l'1 _ _
R Ri,In,liJ
._- _-___-._���� ��� /!/�� Rl R:,IJ�IIIi�I R,i,�lnlc lm:lln`__ .-._ ____ .-___•
hi li phnne 111 rRi,iJ;nlu1 \\,nJ�_„
I il' ti�dlJ
-_ Il
5.2 Registered Ilome Improvement Contractor (III .J, -� f1�}
-� � -iC1. r4ff/7� -- d 7 1 ._ . ..
III(' ('anq,am Nanli or IlIC RC0,1rint Name ReLi,11 allU11 \wuhir
lisp au al U,I r
Signature
SECTION 66:: WORKERS''CCOMPENSATION INSURANCE AFFIDAVIT (M.G.L. c. 152. S 25C(6)i
Workers Compensation Insurance affidavit must be cumple(ed and .,ubmitted with this apphcatrim. Failure Ill pn.IJe
this affidavit will result in the denial of the Issuance of the building permit. _
Signed Affidavit Attached? Yes ..........,per. No .. ❑ - -
SECTION 7a: OWNER AUTHORIZATION TO BE COMPLETED WHEN
OWNER'S AGENT OR CONTRACTOR APPLIES FOR BUILDING PERMIT
I. �i C[�JJQ z� /caft�jj/N as Owner of the subject property herebv
:tuthorize it)act on my behalf. In all maven
!elallve to w,nk authorized by I is building permit application.
I
Date
SECTION 7b: OWNERI OR AUTHORIZED AGENT DECLARATION =�
as Owner or Authorized Agent hereby Jerlaie
that the statements and information on (he foregoing application are true and accurate. to the best of my knowledge and
behalf.
Pn nt Nalnc (l�L��� 7
Slenuturt o(O er or \u(hunteJ.lg6nl Ua(e
ISienedunderthe am%and penalties of er'ur
NOTES:
I. An the
who obtains a budding permit to du his/her own work,or an owner oho hues All unregl,InieJ I'll;[ I, (,,I
(no( registered in the Home Imprusement Contractor (1110 Pr(igram). will imr have access to me .uhitr,uwn j
program or guaranty fund under M.G.L. c. 112A. Other important mfurmatum on the III( Program and
Conetrucflon Supervisor Licensing (('SL)can he found in 780('\IR Regulations I Mq R(i and 1 10 145. rr,peLtl elk 1
' When ,uhstanoal work Is planned• pnnide the nhirmation below:
T�i(ul tl,,ors area ISy. FL imcluding garage. finished ha,enlen mlicN. Jerks or p�nrh�
Gross livmg area iSq. Ft.) Hahu.lhle morn coun(
Number of (Ireplaces __ Nuniher ill hednnan, .-
NtlitlbCi of ha(hnu,ins NuillhCi' „t h,dtih,oh,
Numher ,d dc,k,/ p,n,hc,
1. I,aal Project S,Iuare Ponl,ige' may he ,ub,tl(ulrJ for foil Pr(lIcIt