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6 LORING AVE - BUILDING INSPECTION (2) The Commonwealth of Massachusetts Board of Building Regulations and Standards CITY Massachusetts State Building Code, 780 CMR,76 edition ALEM ReOF S January Building Permit Application To Construct,Repair Renovate Or Demolish a I, 2008 11� One o Family lmg o'tion _ $tufdmgemtnNu er; ter�lYligd , . &ignatpre Buildin tivhissioae sj+4etos o Id gs M 11 / ' IMAM 1000-10000 1.1 Property�ddr s: / 1.2 Assessors Map&Parcel Numbers o , ` I.I a Is this an accepte reet?yes no Map Number Parcel Number 1.3 Zoning Information: 1.4 Property Dimensions: Zoning District. Proposed Use Lot Area(sq ft) - .Frontage(ft) 1.5 Building Setbacks(it) Front Yard Side Yards Rear Yard Required Provided Required Provided Required Provided 1.6 Water Supply:(M.G.L c.40,§54) 1.7 Flood Zone Information: 1.8 Sewage Disposal System: Public❑ Private❑ Zone: _ Outside Flood Zone? Municipal❑ On site disposal system ❑ Check if yes❑ "II �Y'3 RItA.;, 14f, x WNFlt�sl 2.1 wnerio Record: Name(Print) T Address for ice: Signature Telephone SECTION 3 DE2tiP�RiV dI�1QSEDORZ(cheek all that aPPIY) New Construction❑ Existing Building❑ Owner-Occupied ❑ Repairs(s) ❑ Alteration(s) ❑ Addition ❑ Demolition ❑ Accessory Bldg. ❑ Number of Units I Other ❑ Specify: Brief Description of Proposed Work 2: — SECTION 4:ESTIMA E 2` ONS RTJ;C ION C0-1 Estimated Costs: Item Labor and Materialsr, " ;- „ �f5crat Flsenly tBhldgdruif Inidtehw fee is determined:]. Building $ a 2.Electrical $ ©Btaltdard CttyIITO' m'Applicktton Fee 3.Plumbing 4.Mechanical (HVAC) $ t r q SH M5a 5.Mechanical (Fire Suppression) $ �Tota!Ayl��eee` , hee�t No CkedCc AtnoSnit: Cash Amount:6.Total Project Cost: $ a�S-D. ❑Pazd-iitFull q¢utstanding Balance Due: fSCT}UN=S t�1!IS EC 5.1-Licensed Construction Supervisor(CSL) M( , a e t` License Number Expiration Date Name of CSL-Holder V�- List CSL Type(see below) y � ° T Address U Unrestricted(up to 35,000 Cu.Ft. R Restricted l&2 Family Dwelling Signature T % M Masonry Only -7�:� 7 11.S" j 3 RC Residential Roofing Covering Telephone WS Residential Window and Siding SF Residential Solid Fuel Burning Appliance Installation D Residential Demolition 5.2 Re isle Fe H e I provement Contract rrIC) �O 1. L HIC Copan Name or C Rego t ne Registration Number Address G Expiration Date Signature / Telephone SECTION 6 WORT{ERSt IGOMPTsN }TI(Ji)I IU�2ANC AFFIDAVIT(NLG.I 52.¢ 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...........❑ t;�ECT;ION-7s ()WN'ER AC3THldA;Ii�IYt'1? .13�1`,� ". � �N�1Y.rir =. ;r `OVI'1!IERI&AGENti I, e'r �Y 1 as Owner of the subject property hereby authorize to act on my behalf,in all matters relative to work authorized by this building pennit application. Si nature of Owner Date scfi[orl3rd'owlyryx' 13rniCl Tory 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. L l Print Name A T Signature of Owner or Authorized Agent c Date Si ned under the mns and penalties of 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 Improvement Contractor(IIIQ Program),will not have access to the arbitration program or guaranty fund under M.G.L.c. 142A.Other importantinformation on the HIC Program and Construction Supervisor Licensing(CSL)can be found in 780 CMR Regulations 110.R6 and 110.R5,respectively. 2. When substantial work is planned,provide the information below: Total floors area(Sq.Ft.) (including garage,finished basementlattics,decks or porch) Gross living area(Sq.Ft.) Habitable room count Number of fireplaces Number of bedrooms Number of bathrooms Number of half/baths Type of heating system Number of decks/porches Type of cooling system Enclosed Open 3. "Total Project Square Footage"maybe substituted for"Total Project Cosy'