LAFAYETTE ST - BUILDING INSPECTION 10/10/2008 12:52 7812460009 CAMELOT SPECIAL EVTS PAGE 02
ioi JW deltas 1J:ab 9787403131 TROLLEY DEPOT INC
PAGE 04/05
The Commonwealth Of Massachusetts
Board of Building Regulations and Standards Town of
Massachusetts State Building Code, 7ba CMR, 7"edition Wilbraham
U1 Building Pe:mlt Application To Construct, air Building Dept
Re vale Or Demolish a 411.596-280o
On? Or rnvwFae �i Doc)! Ext 119
'
Building Permit N bet: This Sec o 011
4 r
Signature:
Building OrmMlarl6n of Bnil gs
SRCTIO tr SITE 0 Ttotu
Property Address:GOKN¢Y d�f'p oN7 le Q e Sy-, iN •3 Assessam Melt gt Parcel Numbers
1.le.Is this an ae,epsod straY7 yes no M Number
.._— _ eP 1 Nttm`N�Ce ber �'
1.3 Zoalna Information; I,4 Pro
PAY pitaeasions:
7.,ning District 0ropose4 t7u - Lo!Anal sq R? Frerdage(R)
1.5 Bu7e1aQ Setbacwr{R)
Flom vats Nine YartU saw Yard
Required Provided Requited PrpvlAotl
Required Provided
1.6 wafer Supplyr(14.G.L,.40.§54) 1.7 Flood Zone Inford±allon: IA Sewage Disposal System:
Public IMivape A 74>rc: ^` Outside Pt 00d I CQbcek if esa AtR? K11110pal U On site dispneal system Cl
sZcrfoN2' PROPERWOWNERSHIPt
2.I Owned al RecoM-
Name(Print) .AddinI for Semi":
signafire Telephone
SgICTION 3:VESCBIPTION o6 PRppO$D1y IYORKr(check all that apply)
New Con,Rtrtxtion❑ 15xistin8 Btaldirlg❑ Qwncr-Occttpied q Repaira(s) 1) Alteration(s) Q Addition G
Demolition q Acceaeory 8tdg, (7 Number oFunits_
BriefDeswi lion of Other 0 iffy:—d`
p Proposed ork �N3f iC// tnP' X ida� ��tf /d/��/dr f„rua�/OF
3EC770N P:.ESTIMATED CONSTR,e1CTION CosTs
Itocn Batimale"Cosh
Labor add Mataiaia OfT2ris1 fl"Rly
I.-&r Mft S oy JrQ,Od 1. nodding Per Fee:S tOdicate how fee is detamtined:
2.Electrical g ❑Swvuem Cit I own Application Fee
x
; 6)x
1]Total Fees: at'at"at" tmiltiplier_�
3.Plumbing 15 other
C'6
4.Mechanical (l4VAC) S List:
5. N4echanie4l (Fir,
Su resalon 8 Tool All Fees:S
o.'total Pro eat Cost: S Check No._Check Amoune Cash Amount:
1/.9 4 "ry O Paid in Full ❑Outstanding Balance Due: �-
Qcf 4-4
�v,`C4
10/10/2008 12:52 7812460009 CAMELOT SPECIAL EVTS PAGE 03
1C/09/2009 13:05 9787403131 TROLLEY DEPOT INC PAeE 06/06
SECTION 5: CONSTRUCTION SERVICES
5,1 Lfcea"d Coostmxtion Supervtsor(C:SL)
irrC"VO lder�O�i 44 ey eA.fS Liccnae Number Enpi atiam to
Name of CSL•xo �rJbl , List CSL Type(see be)ow)
Q, �Addle 7 ihacri non
ss �/89d U 11nresolcred(up to 35.000 Cu.Ft.)
R RssMcted 1&2"Ay Dwell'
Sign O/p / M masomy Only
- RC Rmideatial Rmfin Co-crin
Telephone WS Residential Window and Sidi
Solid Fhr2&anim lionee Iamllarion
D Residential lotion
5.2 Registered Home Improvement Contractor(HIC)
Hic Company Name or HIC Registrou Name Registration Number
Address
Expiration Rate
Signaure Telepbone
SECTION 6.WORKERS'COMPENSATION INSURANCE AFFIDAVIT(ALGJ_c.152.§2SC(6))
Workers Compensation Insurance affidavit must be completed and submitted with tbis a,7plic,:don. eaiturr to provide
this alfida'it will result in the denial of the Issunace of the building permit.
Signal Affidavit Attached? YOM—........ No...........13
SECnO1r17a2 OWNER AUTHORIUTION TO BS COMPLETED WHEN
O WN9R'S AGENT OR CONTRACTOR APPLIES FOR$L'IIATNC PERMIT • _
c !, as Owner of the subject property hereby
( authorise to act on my behalE in all matters
relative to work authorized by this building permit application.
5P.'wwrot'Owner _ Iaate
SECTION 7bi OWNEW OR AUTOORIZED AGENT DECLARATION
as Owns or Authorized Agent hereby declare
that the statements and information on the foregoing application are nue and accurate,to the best o'iry knowledge and
behalf.
Prim Name
Signature of Owner or Authorized Agent Date
J5iglirlip.nderthe ales and enaides of '
NOTIKS:
1. 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 Improvament Contractor(HIC)program),will NA have access to the arbitration
program or guaranty llmd under M.O.L,c. 142A.Other important information on the HIC Program and
Constmotion Supervisor Licensing(CSL)can be found in 780 CMR Regulations I I O.R6 and I I OAS,reapaetiveiy.
2. when substantial work is planned.provide the information below:
Total floors area(Sq,Fe) (including garages 11nlshod basumcnVattic s,deuka or porch)
Gross living area(Sq.Ft.) Habitable room count
Number of fireplaces Number of bedrooms
Number of bathrooms Number of half7baths
Type of heating system Number of decks/porches
Type ofm4tig system Enclosed Open
3. "Total Project Square Footage"maybe subatilutcd for"Tool Project Cost"