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6 LORING HILLS AVE - BUILDING INSPECTION (6) U c. Z 13-14-a1'10 U C.3 CK SS'l 1 �b I] G� ID .S- cs The Commonwealth of Massachusetts RECEIVED S; �ss, # Board of Building Regulations and Standards $ ► \I C t Massachusetts State Building Code, 780 CMR IT�$PECYro,N ALE � Revised Mr,20!/ Building Permit Application To Construct,Repair,Renovate Or DPW 2 A 01 One-or Two-Family Dwelling Llutl��y� This Section For Official Use Only Building Permit Number: Date Applied: 5/2 2/1 4 Building Official(Print Name) Signature Date SECTION 1:SITE INFORMATION 1.1 Property Address: 1.2 Assessors Map&Parcel Numbers 6 Loring—HiIIs Avenue 2a 004F, 1.1a Is this an accepted street?yes no Map Number Parcel Number 1.3 Zoning Information: 1.4 Property Dimensions: condo Zoning District Proposed Use Lot Area(sq ft) Frontage(ft) 1.5 Building Setbacks(ft) 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❑ SECTION 2: PROPERTY OWNERSHIP[ 2.1 Owner of Record: Loring Hills Condo Unit #1 Trust 6 LorinTHills Avanna Name(Print) City,State,ZiP 6-St2g!N0 H 1.1yS AVENUE vd .978-741 -2003 I" nv@ .NET No.and Street Telephone Email Address SECTION 3:DESCRIPTION OF PROPOSED WORK2(check all that apply) New Construction❑ FExisting Building Owner-Occupied Repairs(s) ❑ 1 Alteration(s) ❑ Addition ❑ Demolition ❑ 1 Accessory Bldg.❑ Number of Units I Other ❑ Specify: Brief Description of Proposed Work - SECTION 4:ESTIMATED CONSTRUCTION COSTS Item Estimated Costs: Official Use Only Labor and Materials i.Building $ a1 1. Building Permit Fee:$ Indicate how fee is determined: 2. Electrical $ �� ,^ 71standard City/Town Application Fee ❑Total Project Cost'(Item 6)x multiplier x 3.Plumbing $ --c7 2. Other Fees: $ 4.Mechanical (HVAC) $ List: 5.Mechanical (Fire $ Suppression) Q �- Total All Fees: $ /�y�qq Check No. Check Amount: Cash Amount: 6.Total Project Cost: $/ �OW. ❑Paid in Full ❑Outstanding Balance Due: (� Lt "o A'Vrt, �c (ti) ' pj(ZE:K Tti1tS �NTL C-Coc` �K) S �i�12 rxrE 1`i SECTION 5: CONSTRUCTION SERVICES 5.1 C nstruction Supervi/sq�{License(CSL) �t�_yt �/_ // /la✓ / �, 7,2 l/( �0-2 License Number t!/ Expiration Date Name of CSL older 0 0A� List CSL Type(see below) No.aarl]Street /n Type Description U Unrestricted(Buildings up to 35,000 cu.ft. R Restricted I&2 Famil Dwelling City/Town,State,ZIP M Mason ry RC Roofing Covering WS Window and Siding �Oh9 � � �C /���� � SF Solid Fuel Burning Appliances 0 ./' � C 1 Insulation Telephone Email address D Demoliflon 5.2 Registered Home Improvement Contractor(HIC) QQ h HIC Registration Number Expiration Date HTC Company Name or HIC Registrant Name L) &� CM/ No.and Street Email address City/Town,State,ZIP Tele hone SECTION 6:WORKERS'COMPENSATION INSURANCE 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...........❑ SECTION 7a: OWNER AUTHORIZATION TO BE COMPLETED WHEN OWNER'S AGENT OR CONTRACTOR APPLIES FOR B ILDING PERMIT I,as Owner of the subject property,hereby authorize tQA / to act on my behalf,in all atters relative to work authorized by this building permit application. Print Owner's Name(E a omc Signature) Date SECTION 7b: OWNEW OR ATJTHORIZED AGENT DECLARATION By emerA&My name below,I by attest under the pains and penalties of perjury that all of the information contai i applicatio is tru and accurate to the best of my knowledge and understanding. P 'nt O 's or Authori t s Na a(L ectronic Signature) Date NOTES:. 1. An wner 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 can be found at mLx .mass. og v/oca Information on the Construction Supervisor License can be found at www.mass.Pov/dps Z. When substantial work is planned,provide the information below: Total floor 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 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"may be substituted for"Total Project Cost" %�c �oururr:uwrnl(�r�G��ia:.rir/uJa/L Office of Consumer Affairs&Business Regulation 5'` _ ME IMPROVEMENT CONTRACTOR -. �A-.;. -� glstratlon: 128315 Type: k -expiration: 3/24/2015 DBA JERRIER BUILDERS BOB JERRIER 83 DUKE LANE Qom_ CARVER,MA 02330 Undersecretary 1 Massachusetts -Department of Public Safety Board of Building Regulations and Standards Gmatruction Supcn ic..r License: CS-073646 -, r ey. ROBERT E JERRJER ' 86 DUKE LN Alfred ME 04002, r , Expiration Commissioner 07/22/2014 f The Commonwealth of Massachusetts Department of Public Safety L5 ; Massachusetts State Building Code (780 CMR) `s as Building Permit Application to Construct, Repair, Renovate or Demolish any Building other than a One-or Two-Family Dwelling Code and Other Requirements for Building Permits The Department of Public Safety has issued these building permit application forms so that municipalities across the state can move toward use of a single permit form and consistent permit application process. The MA State Building Code specifies the requirements of building permits and the applicant is advised to review and be familiar with these requirements in order to avoid some of the common permit application problems. Likewise the applicant should be aware that some municipalities require that the owner confirm, even prior to acceptance of the building permit application, that no outstanding property taxes, water fees, etc. exist. Filing Instructions 1.Please contact the city or town where the work will be done to ensure that the city or town will accept this application form and if any additional information is required, and obtain the correct mailing address. After doing so, print the application, fill in completely and then submit to the local city or town where the work will be done. 2.All applications shall be considered complete and will be reviewed if construction documents, specifications, fee, and other materials that may be required as indicated in the Building Permit Application are included with the application. 3.Please include a check for the Building Permit fee. The fee may be calculated using the information to be supplied in section 12 of the Building Permit Application. The check is to be made payable to the local city or town where the work will be done. 1 The Commonwealth of Massachusetts Department of Public Safety 4�, ! Nlassacnusetts State Building Code(780 C.V1R Building Permit Application for any Building other than a One-or Two-Family Dwelling (Phis Section For Official Use Only) �Buiiding Permit Number: Date Applied: Building Official: SECTION 1:LOCATION(Please indicate Block 4 and Lot 0 for locations for which a street address is not available) F I No.=.n:i Street Cih /Town Z!o Code Name of Building(if applicable) I SECTION 2:PROPOSED WORK Edition ut MA State Code used_ if New Construction check here❑or check all that apply in the two rows below, 4 Existing Building❑ I Repair 0 I .Alteration p Addition❑ 1 Demolition ❑ (Please fill out and submit.Appendix 11 i Change of i.ise ❑ Clrenge of Occupancq ❑ Other Cl Specify 1 Are building plans and/or construction domments being supplied as part of this permit application? Yes ❑ No •s an Independent Structural Engineering Peer Rerieiv required? Yes ❑ No 6" '^er Description of Proposed Work: '4 EMvt rt? A Zq:�OaC.C- E1115TINQ �r 16 £t��Fl�jLy(, ✓•• 11 LGIC$ � h�A Nl.W �th2t1 . ( I. SECTION 3:COMPLETE THIS SECTION I=EXISTING BUILDING UNDERGOING RENOVATION,ADDITION,OR CHANGE IN USE OR OCCUPANCY ( Check here if an Existing Building Investigation and Evaluation is enclosed(See 780 CMR 34) ❑ ExisErLg Use Group(s): I Proposed Us,Group(s): I SECTION 4:BUILDING HEIGHT AND AREA Existing f Proposed ) r— • No.of Floors/Stones(incivcie basement levels)R Area Per Floor(sq.ft.) TV� T Total A.ta(sq.f t.)and Total Height(ft.) I I I SECTION S:USE GROUP(Check as applicable) A: Assembly A-1 ❑ A-2❑ Nightclub ❑ A-3 ❑ A4 C A-5❑ j B: Business ❑ h E: Educational F: Factory F-1 % P2❑ I H: High Hazard 14-1 ❑ H.2❑ H-3 ❑ H-1❑ H-5❑ 1: Institnitional !-1 ❑ 1-2❑ I-3 Cl 1-4❑ 1 M: Mercantile❑ R: Residential R-10 _R-2❑ R-3❑ R-4❑ S: Storage S-1 ❑ S-2❑ U: Utility❑ 1 Special Use❑and please describe below: i Specie! Use. ._.. 1 SECTION 6:CONSTRUCTION TYPE(Check as applicable) ' IA ❑ ?B ❑ � IIA ❑ I1130 i ❑IA ❑ IIIB ❑ IV IVA ❑ VB ❑ SECTION 7:SITE INFORMATION(refer to 780 CMR 111.0 for details on each item) t } — Water Supply: j Flood Zone Information: Sewage Disposal: Trench Permit: I Debris Removal: Public❑ I Check if outside Flood Zone G Indicate municipal❑ A trench will not be I Licensed Disposal Site C required❑or trench t or specify: r:va.e or iadcntif) "Lone: or on site.sys.em❑ I permit is enclosed❑ Railroad right-of-way: Hazards to Air Navigation: M—A iI toric_C'ommdi setn ReviewPrycess: i l of Applicable 01 is Structure within airport approach area? Is their review completed? or Consent to Build enclosed❑ Yes❑ or No I I Yes❑ No X SECTION 8:CONTENT OF CERTIFICATE OF OCCUPANCY Edition of Code: Use Group(s): Type of Construction: Occupant Load per Flour. • Does the building mnhin an Sprinkler Systcrn?: — Special Stipulations: _ . SECTIONS: PROPERTY OWNER AUTHORIZATION } iNarne znd Address of Property Owner i Name(Print) \o.and Street City/Towr. Zio i Property 0,.ne(Contact Information: t I` Titl, Telephone No.(tausiness) Telephone No. (cell) e-inail address L`applicable,the property owner hereby authorizes I Name Street Address City/Town State %ip { to air'nit the cronerh owner's behalf,in al:matters_relative to work pp authorized by this building permit application. 1 SECTION 10:CONSTRUCTION CONTROL(Please fill out Appendix 2) - (Ti building is less than 35,000 cu.ft.of enclosed space anal/or net under Construction Control then check here 0 and skip Section 10.1) 10.1 Registered Professional Responsible for Construction Control i ti( Name(Re;s:rant) Teiephone Nu. e-mail address ( Registration Number ! Sireet Ad,.d%ss City/Town State Zip Discipline Expiration Date I 10.2 Carerl Contractor TPM t.LC f Cmn;pany\isme t f Rv5e17+ AEf1.tZjM _ C5 -olf&4� _ __-- t Naine o:Per.=.on Rn<_ponsibie for Construction License No. and Type if Applicable { 5de buker Lpewaf �MRNf t�Jly_ v14002. . Street Address i'ity/Towr. State Zip 1 12o-L 1fr 3134 fah,.cn�� �_-elephcme.No.(business) Telephone No.(cell) address 1 SECTION 11:WORKERS'CMMPENSATiO\INSURANCE AFFIDAVIT(M.G.L.c.152.§25C(6)) j A Workers'Compensation Insurance Affidavit from the MA Department of Industrial Accidents must be completed and subn':i'aedmi'h ibis appL+cation. Failure to provide this affidavit will result in the denial of the issuance of the building permit. Is a signed Affidavit submitted with this application? Yes❑ No ❑ r SECTION 12:CONSTRUCTION COSTS AND PERMIT FEE Estimated Costs:(Labor ( ' cm and Materials) ( Total Construction Cost(from tiem 6)=S _ Builaieg 5 Building Permit Fee=Total Construction Cost x_(Insert here i 2.Etectrica[ 5 } appropriate municipal factor)=S 3.Ple:ab£ng Note:Minimum fee=S (contact municipality) 4.Mechanical ('r.V AC) r S � � 5.Afechan;cai !Other) S i Enclose check payable to 6.I-otal Cost 5 (contact municipality)and write check number here SECTION 13:SIGNATURE OF BUILDING PERMIT APPLICANT f By c;icring my name below, 1 he,clay attest under the pains and penalties of perjury that all of the information containod in this application is true anr,accurate to the best of my knowledge and understanding. � �J _ L )Z, - rIN1.4� 1,4_ f a� 47WAICOL— ZU� _ ZbJ b Mc.-.se print and sign name Title. Telephone No. Date LPrivC I.�MhN M r, _0g017 Stre,.t .Address City/Town State Zio _ I ` M mi.:pal Inspector to fill out;his section upon application approval: 1 Name Date The Commonwealth of Massachusetts Board of Building Regulations and Standards CITY OF Massachusetts State Building Code, 780 CMR SALEM Revised Mar2011 Building Permit Application To Construct, Repair,Renovate Or Demolish a One-or Two-Family Dwelling This Section For Official Use Only Building Permit Number Date Applied: 5/2 Building Official(Print Nunc) Signature Date SECTION 1:SITE INFORMATION 1.1 Property Address: 1.2 Assessors Map& Parcel Numbers —E�Ier—ing—Id .,1t� •,�nu� —21 nnn� 1.1 a Is this an accepted street?yes_ no Map Number Parcel Number 1.3 Zoning Information; 1.4 Property Dimensions: _.�031d4 Zoning District Proposed Use Lot Area(sq fl) Frontage(ft) __ 1.5 Building Setbacks(ft) Front YardT Side Yards Rear Yard Required Provided Required Provided Acquired I Provided I 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? Check if yes❑ Municipal❑ On site disposal system O SECTION 2: PROPERTY OWNERSHIP' 2.1 Owner'of Record: r,orina Hills Condo Unit #1 Trust rnrin� ll g Avpnnp Name(Print) City,State,ZIP —6 b9R�-Iu6—H�.bS—AUEtuU.E�9 7 8-Zd i _y n n3� _ No.and Street Telephone Email Address SECTION 3:DESCRIPTION OF PROPOSED WORK'(check all that apply) New Construction❑ Existing Building Owner-Occupied j Rcpairs(s) O j Alteration(s) ❑ Addition ❑ i Demolition ❑ Accessory Bldg.❑ Number of Units 14 Ocher ❑ Spccify:. Brief Description of PronoSed Work': _ v_fi. 1 -�l SECTION 4:ESTIMATED CONSTRUCTION COSTS Item Estimated Costs: Official Use Only Labor and Materials) I. Building S �h�/',tea ) I. Building Permit Fee, S J' /D, Indicate how fee is determined: tandard City/Town Application Fee 2. Electrical $ —^C' O ----Project Cost'(Item 6)x multiplier__x 3.Plumbing $ 2. Other Fees: S 4.Mechanical (HV.AC) $ _—�� List: _ 5.Mechanical (Fire Su ression) S Total Ail Fees:$ — Check No. Check Amount Cash Amount 6.Total Project Cost: $ //- �/v 1 — _ 0 Paid in Full 0 Outstanding Balance Due: SECTION 5: CONSTRUCTION SERVICES 5.1 C nstructfon Supervis License(CSL) n _ /J' '� �� _ License Number Expiration Date Name of CSL older List CSL Type(Sec below) No.and Street Type Description /; , i U Unrestricted Buildin su to35,000cu.ft.) R Restricted 1&2 Famil Dwelling City/Town,Sate,"/.[P M Masonry RC Roofing Covering --- ---- WS Window and Sidin L SF Solid Fuel Burning Appliances ` Insulation Tel- hone Email address D Demolition 5.2 Registered Home Improvement Contractor(HIC) HIC Registration Number Expiration Date HIC Company Name or IIIC Registrant Name No.and Street Email address City/Town, State,ZIP Telephone SECTION 6: WORKERS'COMPENSATION INSURANCE.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...........❑ SECTION 7a:OWNER AUTHORIZATION TO BE COMPLETED WHEN OWNER'S AGENT OR CONTRACTOR APPLIES FOR BUILDLNG PERMIT 1,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. print Owner's Name(E ec6-onie Signature) L >/Dare / SECTION 7b:OWNER'OR AUTHORIZED AGENT DECLARATION lay ente my name below,I,�by attest under the pains and penalties of perjury that all of the infomtation contai 3'p',[ s/applicatio Shand accurate to the best of my knowledge and understanding. / Print OBme 's br Authori'ted Age�t s Name(Electronic Signature) Date NOTES: I. At? wrier who obtains a building permit to do his/her own work,or an owner who hires an unregistered contractor (nut 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.Otter important information on the HIC Program can be found at wm .nm s.eocigcn Information on the Construction Supervisor License can be found at o:v,1v.mas�ov:dpss 2. When substantial work is planned,provide the information below: Total floor area(sq. ft.) (including garage,finished hasemenvattics,decks or porch) iGross 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 3. "Total Project Square Fodtage"may be substituted for"Total Project Cost"