0090 LAFAYETTE STREET - BPA-07-832 ;>
CITY OF S UEN I, I L SSACHUSETTS
BL'n=NG DEP NRTJtEb7
° 120 WASHINGTON STREET,3' FLOOR
TEL (978) 745-9595
FmX(978) 740-9M "
KIMBERLEY DRSSCo
MAYOR 7 THoma ST.PIERRE
DIRECTOR OF PUBLIC PROPERTY/BUILDING COtiL�RSSIONER
Construction Debris Disposal Affidavit
(required for all demolition and renovation work).
In accordance with the sixth edition of the State Building Code, 780 CMR section 111.5
Debris, and the provisions of MGL c 40, S 54;
Building Permit# ' is issued with the condition that the debris resulting from
this work shall be disposed of in a properly licensed waste disposal facility as defined by MGL c
111, S 150A. : .
The debris will be transported by:
(name of hauler)
The debris will be disposed of in
(name of facility)
(address of facility)
signature of permit applicant
date
ilcbnstt:dx ': -,
What is the current use of the Building? ✓U, 04�CA
Material of Building? C=n f dwelling, how many units?
Will the Building Conform to Law1 Asbestos?
Architect's Name J ��4 �,/�
Address and Phone ) 7 -J L. Lp S� �pIw)Le- !(T7) o 2-7
Mechanic's Name ) m*1 1z-u)0
Address and Phone 17
Construction Supervisors License# CS O`� b I �j -31-1IC Registration#
Estimated Cost of Project$ 1 E;�z70 Permit Fee Calculation
Permit Fee$ Estimated Cost X$7/$1000 Residential
Estimated Cost X$11/$1000 Commercial
An Additional $5.00 is added as an
Administrative charge.
Make sure that all fields are properly and legibly written to avoid delays in processing.
The undersigned does hereby apply for a Building Permit to build t thetoo _he above stated
specifications. Signed under penalty of perjury X `ter
Date o
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' � ✓eie-PammeonuealC/ o�,.��anaelld :::
BOARD OF BUILDING REGULATIONSe j
License: CONSTRUCTION SUPERVISOR j
8` Number: CS 086143
Blrlhdate: 1 110111 96 4
_ Expir®s: 11/0112 0 0 7 Tr.no: 861-43 -
Restricted: 00,
,MICHAELG BERNIER
�-16 CHANDLER ST'- .
NEWTON, MA 02458 Administrator
i
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Erry-OFS'ALEC --
PUBLIC PROPERTY
DEPARTNIENI T
titkWFJU.EV oRMC0LL
MAYOR 120 WASMNG"N'MEEr•Ste;,HwcSACHLSLI-M 01970
TEL 978-74S-9595•FM 976-740.98"
APPLICATION FOR THE REPAIR, RENOVATION, CONSTRUCTION,
DEMOLITION OR CHANGE OF USE OR OCCUPANCY, FOR ANY EXISTING
STRUCTURE OR BUILDING
1.0 SITE INFORMATION
Location Name: ` 8 Building:
Property Address: 1® p? z r1j�t
property is iocated in a;Conservation Area Y/N Historic District Y/N Lr -
2.0 OWNERSHIP INFORMATION
2.1 Owner of Land _
[AdLdress:
L 6 - 1_t_c-
/ �,�C�1 r�Z�
3.0 COMPLETE THIS SECTION FOR WORK IN EXISTING BUILDINGS ONLY
Addition Existing
Renovation Number of Stories Renovated
Change in Use New
Demolition Existing
Approximate year of Area per floor (so Renovated
construction or renovation
of existing building New
Bcief Description of Proposed Work:
Mail Permit to: