6 LORING HILLS AVE - BUILDING INSPECTION (3) l Sp e_-7a
80 0 l Z D 3 REGEIVEO
11 ICES
I D-2-
1 B_3 1NSPEGTIONAL SERV
r Y The Coinmonwcaltit of Massac?iusetts -- lReviseniiMm,
t)3Hoard of,Buildma Rdoulmions avid Standards
a S4LFM �Massachusetts State 4wld'ng Code 780 CMIRBuilding Pefrn)t Application To Col�struct,Repaur,Renova!e Or DemoliisG,o
One or Titb-£am 7y Drae'lling
This Section For Official Use Only
Budding Permit A imbec _ Date, plied:
6 i Ir na Official(?-'im Name) Signature _ � - Date
-f—
LF,2g1ON 1`: SITE INFORMATION
'i I Property Address .DI r D2 r D3 r D4 7 2 Ats rssors\lap&Parcel Numbem
_S Lor -n-g H4-1J_.Avenue-=._ ' __21 ._ 00G!i
1 1 a s this an a ccpted stiet.t°ycs no _-_ Map}Ju Cher _ t a--- --Number
--
i 13 Zoning-Information 1.4 Proper( Dimensrons
Gonmg District mposed Ilse
i.ot Aiea,{s< tt) Frontage(fr) 1
d:5 Bysldng:Setbacks
-Grunt Yard Side Ysrtls Rear Yffrd.
Requueff Provided Required _ Pros idnd _ Required j Yxow icl
+ 1.6 Water Supply:(M i(TL c 40.§54) 1.7 flood Lone Information: 1.8 Sewage gi,sposal System: r
'Trans ou siue ood Lone'
I Public❑ Pnva1C❑ -'- I r
Check if yes❑ J M mic+pal❑ Oil site diiusal System 0
. i
SECTION 2: PROPEdtTY OWNF,RSIBY"
1k.1 Owner'of Record:
1 -for ag--H11 Gsrc E3rst #7 Tr,',��-v 400 Hiahlan3
Nivne(.Print) - '^t:9tb,'tuue;7.tP
6 Lorina Hill_ i
;;o Harr Sinet Celephmie m u. rest
Su( PION z DFSCRI11 10N OF?ROPOSED WORKa(checkall thatapply)
_ i
Ne>n Construction Cl FFxi sting&nld.ng'❑ Owner-Occupied l Repairs(s). d Aftcration{s) ❑ �. dtlinop ❑ '
_
Demolition ❑ Accessory Bldg.❑ _Num6er of U its ,_ 1 Other ❑
Bncf Description of Proposed Works;--R P-1 LCL_,..s dingg....on 4 units_----.--
-------
SECTION 4 FSTIMATY.D CONSTRUCTION COSTS
t ; Estimated Costs
em Official Use Only
� [labor and Nlaterrals) _ _
1.:Building: IS24r000-.0() 1,.+Bmld z mgPicnrjt .$ -_ -bdicatc how fee is deter
mmed.
{ ❑-Standard City/Town Ap`pii.ation Fez
2.Elea-ical
--- -i-- G Tbtal Piolect Cost'(Item fi)x multlplizr x
a,Piumbing S 2. Othu.Fees: S -
4. Mechanical.jHVAQ IS List -
5.Mechanics!
( rc S Total 4I(Fees
5.iipPresston) I I
Check No. _Check Amount ---Cash Amount.
t 6.-Total Project Cost S', 24,OOb, 0 D ❑Pud to poll---
wl C Outstanding Balance Due i
(OK T
,IN
I�06 fL-V 1-, ZIT2I69— EX P -7—22— t(e
' SECTION 5: CONSTRUCTION SERVICES
� 5 I -og-s-P'ttctton Superviso License.(CSL)
Lwcn<c Nuuilxr F,1,psa.ton Date
Nam rm C .iioldar�. j
�(J ✓f/ r /// t t tsil St.I}pi.(��e below}. �. .
'No and St eci.. r' - 1 pe Description �.
/ f )� r� �u• a ,. .-v p. U�Unrestncred(Bwidints up to 95,000cu.ft.).
Rertncted 7&2 Fanth DNtellmg
Ciblr orst stint,ZIP l IM
k0 Roofiqg Coveni
{ wS V, rdnw and S rhn
1 "il66rsJ � �F^ Y/r a, SF Solid Fuei Burning Appliance
`Gi� �11.«�j_.,+vf.�� _I/��rz'%f✓_ .(��r I^ ( insu a an �,
I c ephow,• _ Entail addtc>,. D Demolition
5.2 Registered Rome Improvement Contractor(7IIC
... I31G.Registration N'umxrEkpiranon Date
r.IC Gompry Name or}3jC_Rcg straflrivzm,e
No and S(reet.. Erne'[
, -na 1 a address
Ctty/Town,State LIP Sclephone
SECTION 6: WORKERS COMPENSATION INSURANCE AFFIOAYIT(M.G.L.c. 152.§.25C(6))
t Workers Comp nsatibn Insurance affidavn mast be.completed and`submitted-with this application Failure to provide
th i_affidavit will result in the denial of the Issuance of the bwfmhg permit
'Sinned Affidavit Attached? Yes ....: ❑ No : . .....❑
SECTION 7a:OWN ER AUTHOR12ATION TO 13L COMPLETED WHEN
OWNER'S AGENT'OR CONTRACTOR APPLIES FOR BLILDING.PL'RMI F .
as Ow`nerof the subject p//mpe+7Y hercbl aGthonze � �.1�� �i F'Y�j .,
to ao(fo'h my behalf,in a! ratto reiativo to we k autfioozed by this b,.umng permit application
%Y`! -�-`i.. � '�r�'J�_ �
Vn t Ow Dr.g'hp tie(h aVCSigYialfire Date
r 1 t
SECTION 76:OWNER'OR AUTHORIZED AGENT DECLARATION -�
-i3y entering my name below;I hereby apest under the pains and penalties of perjury that all of the information
� contained in this application is true and accurate to the best of m) knowledge and'understa_nding. X{
Peirt Or tier uu A�;nonzar].Agents Name'(E]cctrone Signature) Date f
NOTES:: --
1 An Owner who obtains building permit to doShisi'her own work,of art owner who hires an unregistered contractor
(not episiered in the.Home improvement Contra:tar(FIQ program),will not have access to the arbitration.
program oruurranty fiimd,under tif.C?I,.c 142A"Other important information on the htlCProgram can be found at
Information ein the Construction SuperviscirLicense car,be found at
2_ When substantial wort::is Planned,.provide the:niformatioa belowi -
Total floor area(sq ft.) _ {mciud nggarage,fuus5ed basementlattic5 decks or porch)
Goss living area(sq.�) ._ �. - Habitable room count — vi
N.umher of fireplaces !_ Numberofbedrooms {
Number of bathrooms Numbc ofhalt7haths
.ypeofheatingsysten . _ Numberof decks/porches.._
S type of coolme ysterr _ Enclosed _ Open — .
"Coca/ project Square Footage`may be substruned.for`"Focal Project Cost':