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8 HARMONY ST - BUILDING INSPECTION (2) .;,.. � 3 /°�.�,�s ©,,e, C�er✓�c $� �{oq = %��/�� l TITS y The Commonwealth of Massachusetts, Board of Building Regulations and Standards \II'NI('ll AH I l Massachusetts State Building Code. 780 CMR. 7"'edition I,SI[ Building Permit Application To Construct, Repair, Renovate Or Demolish a Rei tw .lam' , I One- or Tao-Funtil. Divelling This Sect iu :�Lial Use Only Building Permit Num r. Date A plied: Building Commissioner/ Inspector of B ild s Date i SECT IO TE INFORMATION _ 1.1 Property Address: 1.2 Assessors Map & Parcel Numbers A (/ 5 r — la Is this an accepted street?yes__ no .m ... Map Number Parcrl Numher 1.3 Zoning Information: 1.4 Property Dimensions: Zoning District Proposed Use Lot Area(sq fo Frontage tlil 1.5 Building Setbacks (ft) Front Yard Side Yards Rear Yard ! Required Provided Required Provided Required 1.6 Water Supply: (M.G.L c. 40. §54) 1.7 Flood Zone Information: - 1.8 Sewage Disposal System: Zone: Outside Flood Zone'? Puhlie❑ Private❑ _ Check if yes❑ Municipal ❑ On site disposal systcin ❑_Ji SECTION 2: PROPERTY OWNERSHIP' 2.1 Ownerlof$ecocd: slnne(Print) Address for Service: ---- --- — 9 Telephone i i'et!auurc Telc P SECTION 3: DESCRIPTION OF PROPOSED WORK (check all that apply) � New Construction ❑ 1 ExistingBuildi Owner-Ouupie epairsls Alter:uion(s) ❑ I ,\JJnrm ❑ _ — Demolition ❑ Accessory Bldg. ❑ Number of Units_ Other ❑ Specily:_ Brief Description of Proposed Work':_ ' _ I - i --1 SECTION 4: ESTIMATED CONSTRUCTION COSTS Item Estimated Costs: Official Use Only (Labor and Materials) 1. Building $ 1. Building Permit Fee: $ Indicate how fee is JelernuncJ: ❑ Standard City/Town Application Fee 2. Electrical $ ❑Total Project Costa (Item 6) x multiplier x 1. Plumbing $ 2. Other Fees: $ 4. Mechanical (HVAC) .$ List: — 5. Mechanical (Fire $ -- Su cession) Total All Fees: $ 8 ELF Check No. Check Amount: Cash :\ntnunL___ j b. Total Project Cost: $ o ❑Paid in Full ❑ Outstanding Balance Due:_____ ! �(00 r SECTION 5: CONSTRUCTION SERVICES 5.1 Licensed Construction Supervisor(CSL) 4y 76 �— �— o License Number. Exprauun Dale Name�)I CSL- floler .� � (9 b — T rlJ. r,' List CSL Type(see below) Q �21 Type Description \JJre s C Unrestricted(Lip to 35,(N)0 Cu. Ft.) St U L R Restricted 1&2 Famih Dtselhne, OD C Residential Rooline Catering Telephone \'S Residentialm :m\Vdtm d Siding F Residential Solid Fuel Burnlue .\t thancc Inst.illauuu Residential Demolition 5.2 gegtstered�lome Improvement Contractor(HIC) L r� Cr(,li'c 'Z� �' inns / G\ -- HIC Ctp4ryMm ur HIC RislragL Yame Registration Numher Addr• s Expiration Date Signature Teleplwne I SECTION 6: WORKERS'COMPENSATION INSURANCE 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 7a: 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 mattei., relative to work authorized by this building permit application. � I I Signature or Owner - Date SECTION 7b: OWNEW OR AUTHORIZED AGENT DECLARATION . 1, as Owner or Authorized Agent hereby declare that the statements and information on the foregoing application are true and accurate, to the best of my knowledge and behalf. Print Name Signature of Owner or Authorized Agent" Date _ (Signed under the pains and penalties of perjury) 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 M.G.L.c. 142A. Other important information on the HIC Program and Construction Supervisor Licensing (CSL)can be found in 780 CMR Regulations I IO.R6 and 110.R5, respectively. _' When substantial work is planned,provide the information below: Total floors area(Sq. Ft.) (.including garage, finished basement/attics,decks or porch) Gross living area(Sq. Ft.) Habitable room count Number of fireplaces Number of bedrooms _ Number of bathrooms Number of half/baths rvpe of heating system Number of decks/porches j Type of cooling system Enclosed Open 3. "Total Project Square Footage- may be substituted for "Total Project Cost"