488 LORING AVE - BUILDING INSPECTION ' The Commonwealth of Massachusetts
Board of Building Regulations and Standards CITY
Massachusetts State Building Code,780 CMR,7`"editio OF SALEM
e I I _ Revised January
JIltlA Building Permit Application To Construct,Repair, novate Or emolish a 1, 2008
One-or Two-Fmnily Dwelling
Buildittg PerttiiCNumber: ate 4
Signature.'
Build)ng Cotmntssionerl Ipspe °, f}3m drit : ;° a
1.1 Property Addr s: 1.2 Assessors Map&Parcel Numbers
L 1 a Is this an accepted s ?yes_ no Map Number Parcel Number
1.3 Zoning Information: 1.4 Property Dimensions:
Zoning District, Proposed Use - Lot Area(sq ft) - - Frontage(R)
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❑ ,.
' -F2�C'FYON 2. PRC��. . .,_��IISITI3!•.'
2.1 Owner'of ecorcc��
Name(print) ����— - Address for Service: 61 _
Signature Telephone -
SECTION 3 DE CRYFI[O1+T,:r' R( FUSEI XVOR{'(check a14that app►y)
New Construction❑ Existing Building❑ Owner-Occupied ❑ Repairs(s) ❑ Alteration(s) ❑ Addition ❑
Demolition ❑ Accessory Bldg. ❑ Number of Units Other ❑ Specify:
Brief Description of Proposed Work': CG icrt o" vG
C r SECTION 4:ESTIMAi CEAOIY�uTRIJC CIOlY',COST§
Estimated Costs
Item -' Affreial Use Only
Labor and Materials s,
1.Building $ 'Y gutl mg PermrtFae $ Indieate'how fee is determined:
2,Electrical $ 8taritiardtyIAptShcatian:Pee
k FotaPP etsEE C ,,Cxtem 6)X�d?49001ier x
3.Plumbing $ `1 f)fk ill' 'r
4.Mechanical (HVAC)
5.Mechanical (Fire
r6.uppression) $
Cheek Amount:'. Cash Amount:
Tol Project"Cost: $ / ( �pald tnPg1I L1.Outstanding Balance Due:
��
s>�cTioN�?f+�ttiri�rs7<?Rlt��o;"sErt vtc�s
5.1 Licensed Construction Supervisor(CSL)
L A,� License Number Expiration Date
N—amef o'f!CSL--Holder V`- List CSL Type(see below) y
Address n ^ U Unrestricted(up to 35,000 Cu.Ft.
6�If,� '� R Restricted 1&2 Famil Dwellin
Signature M Masonry Only
RC Residential Roofing Coveringt
Telephone \ WS. Residential Window and Sidin
SF Residential Solid Fuel Bumin A liance Installation
D Residential Demolition
5.2 Re 'stere H_ ue I provement Contract rpuc) 41 5�_
HIC Corypan Name or C Red tt me
G. Registration Number
F 7 -� at !�
AddresGh p Lam ` �� �i 7k 74�L-E � Expiration Date
Signature ` / Telephone
SECTION,6 WORI{ERS'COMI'E_NSr1�'Li01lI IN(�i1RANCE 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 �
5FCTI(�N9asOW�GER�ICJTH�R,�'LATI N3',bF����1'�r��'�+'�z�WiIEN,� :;;
OlVI�IER'S AGENT.OR='CONTRAGTOR'APP� ;FOR;BUII7 INCi I3ER1GIT1'. -
�A as Owner of the subject property hereby
authorize` to act on my behalf,in all matters
relative to work authorized by this building permit application.
Si-mature of Owner Date
SECIbN �b'23WN/�'RI1 .';. 1rliGENT DEAL RATION:,
as Owner or Authorized Agent hereby declare
that the statements and infoe foregoing application are true and accurate,to the best of my knowledge and
behalf.
Print Name L^ -
Signature of Owner or Authorized Agent Date
(Signed under the inns and inanities of u N -
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(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 110.R6 and 110.R5,respectively.
2. 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
ths
Number of bathrooms Number of decks/half(b porches
Number of decks/po
Type of heating system rches
Enclosed Open
Typeofcoolingsystem
3. "Total Project Squaze Footage"may be substituted for"Total Project Cost"