BP-39286RIESIDENTIAL
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1. Date plan reviewed: �/
2. DENIED (see project review
worksheet): Date:
3. HOLD
reason: t.p G 0 Ts o n/ 47 774 f Tz *7 r -z, - -7 Date: c / d
4. HOLD subject to Zoning Board of Appeals action: Date:
Comments:
Irspector's Signature: Dater
-
Applicant informe of o Date:_ _ Time: Clerk:
�C -- --
omtnents: i
LEM
. er_uit Fee: $ S. O 0 Less Application Fee $ 25.0 ;.
'rot-.Ip `" 0 Remain;ng I?alar=ce: $ S O, O 0
TOTAL I Fes: 7 S,00 Gross Area - New Construction total sq. ft.--
Gross Area - Alteration total sq. ft.,
Permit Issued T,_ CDs✓ S %iP u C T/ o tt ILZA, 12AI % L
.. . ....
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(/ S1,77//
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RESIDENTIAL
❑ FOUNDATION ONLY
l
$25.00 APPLICATION FEE IS NON'-REFTIND--ABLE & NON -TRANSFERABLE
F NLiMBE[? OF PUNS SUBMITTED:
1.1 Property Address:_ I q 2. ►'✓� !56 `7r't ���
SITE PLAN SUBMITTED: P<es Ono
1.2 assessors Map &Lot Number: �
Map 7? Lot 1(,6
Nearest Cross Street:
Subdivision Name:
1.3 Historical District ❑ yes ❑ no
Total Land Area Sq. Ft.:
Has application been submitted to the Historic Commission':
❑ yes ❑ no Date:
1.4 Water Supply (MGL c 40 § 54): M f
1.5 Sewage Disposal System:
C:\bldg.fo r, s\Bid a n re s.•A-od Page 4 1:ev. January 20-05
C:\bldg.forms\Bldgapp.res.wpd
Page 1 Rev. January 20'J5
RESIDENTIAL
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2.1 Owner of Record:
t0 RoWe-5 (Jkcxr
Gi�rry aigA 0-aA Qn.e- ; rel c, n
GoAop) , dg Da l l o b 1 1- 3k5-- o wi
Contact Address Phone Number
Name (print)
2.2 Authorized Agent: �
�=, 13 0kc �ban� �«������, ln� s/,�S
� ��� � �� �� � � � G
�O rre+ro
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rtgyjc�evtc� � n3 ( QB— qvi
Name (print)
Contact Address Phone Number
zA �• °�. y.i y.o r /-..hn'�
% >�; . 2 €?'
3.1 Licensed Construction Supervisor:
Licensed Construction Supervisor 1/
Not Applicable ❑
License Number c
Address�1)C-I< 5vre-eT 0
Expiration Date
Signature � Telephone
3.2 Registered Home Improvement Contractor:
Not Applicable ❑
Are you a Home Improvement Contractor subject to (780 CMR-6)? ❑ yes ❑
no
If no, go to the next section!
Are you claiming exemption from the requirement? ❑ yes ❑ no
If yes, submit the
required affidavit!
Company Name
Registration Number (if none, state "none")
1 Address
Fs�inature -- Telephone
Expiration Date
3.3 For Residential Remodel Work Only
1
PERSONS CONTRACTING NVITH UNREGISTERED CONTRACTORS DO NOT HAVE ACCESS TO THE CTUARANT Y FUND:
QUESTIONS OR COIv1PLA1NTS call or w rite:
Nome improvement Contractors Registration, One Ashburton Place - Room 43.01, Boston, M4 02108, (617) 727-8558
i Uvalers Name (printZ
1
Signature - - -
by sighing the above, the home owner acknowledges that there will be no eligibilt-y to the Guaranty Fund
Dale.:_
34H0meowner Exem t ron-- One & _1 w0 Family Only
FOR HOMEOWNERS WHO INTEND TO PERFORM AND BE RESPONSIBLE FOR TRFTR OWN PROJECT
109.1.1 Licensing of Construction Supervisors: Except "or those structures governed by Construction Control in Section 116.0, effective July 1; 1981, no individual
shall be engaged in directly supervis'mgpersons engaged in construction, reconstruction, alteration, repair, removal or demolition involving the struchuai elements of ouildings
or structures, unless he or she is licensed in accordance with the rules and regulations promulgated by the BBRS entitled Rules and Regulations for Licensing Construction
Supervisors.
Exception: Any Homeowner performing wail-, for which a Building Permit is required shall be exempt from the provisions of this section; provides that ifa Homeowner
engages s
a _son( for
s � hue to do w rk o that such Homeowner � c er shall act as supervisor. � .) e rsor.
r this
For thepurposes- f t S o hr, s.,ction only; a "Hameowmer" is defined as follows: Person(s) who owns a parcelof land on which he/she resides or intends to reside, on which
there is, or is intended to be, a one or two family dwelling, attached or detached structures accessory to such use and/or farm structures. A person who constructs more than
one home in a two-year period shall not be considered a Homeowner.
:f you are applying under this section sign below:
Signature:
Your signature carries certain responsibilities, including but not necessarily limited to, general liability
RESIDENTIAL
NOTICE To LICENSED CONTRACTORS: The Building Code provides in the Rules and Regulations section that any licensed Construction
Supervisor, whether or not they have taken the permit are responsible for code compliance. (see Appendix of 780 CMR R5.2.15)
A11101> :-ot
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 ❑
n_
0
❑ new construction* ❑ addition ❑ alteration ❑ repairs ❑ chimney/ ❑ woodstove
(energy report required) (energy report required) fireplace
❑ deck ❑ pool ❑ accessory bldg. ❑ replacement window/door Vther ❑ demolition
(shed/garage) no. of windows doors (specify below): (specify below):
* If new construction, please complete the following:
Single Family: no, of bedrooms no. of baths
Two Family: no. of bedrooms unit 1 no. of baths unit 1
no. of bedrooms unit 2 no. of baths unit 2
❑ Furnace (hot air) - fuel gas (natural or propane), fuel oil, electricity, other (specify):
❑ Boiler (heating)- fuel gas (natural or propane), fuel oil, electricity, other (specify):
_
❑ HVAC (combined unit) - primary fuel, natural gas, propane, electricity, other (specify):
❑ Air conditioning - (separate unit)
❑ None of the above to be provided
❑ Hot Water: Gas Electric Fuel Oil Other
Brief' Description of Proposed Work: �
,
�€'
r:>�,��/�.'�.�'..:ate: , r.., v✓o , r ;,Y ..:�
//�`�.,; . !/� � r � _n
Item
Estimated Cost ($) to be completed by permit applicant
1. Buildinlay
2. Electrical
3 Plumbing
4. Mechanical HVAC
5. Total = (1 + 2 + 3 + 4)
* Estimated Total $ "', 2-uv
,;sb/✓- ��%a" �_ "�.a/'kfi`' i x ,Sq a f.
s "
(please print)
i
1,__ Mt?t-��c,n _,as Owner of the subject property hereby authorize
to t 0L3. n behalf 'n. all ;natters relative to work authorized b this -
Y y s building permit application.
_
signature of Owner Date
r ,Y W
r s d <� x
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1071
s , as Owner/Authorized Agent hereby declare that the statements and information
on the foregoing application are true and accurate, to the best of my knowledge and belief.
Signed under the pains and penalties of perjury.
ignature of Owner/Authorized Agent Date
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6 17 8 1 9 110 11 112 1 13 114 5 16 17
LEGEND
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i ISSUED FOR BID 04/De/05
No. ISSUE DATE
D RESIDENCE AT MISHAUM POINT
WSHAUM POINT, MASSACMSEPAS
c
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ILL^l�
A
ROBERT A.M. STERN ARCHITECTS
460 W-L 34L STREET, NEW YORK NY 10001
TEL (212) 96'1-5300 •PAX (212J 96T-5566
SITE PLAN
Project No.
A003041.02
Data
CAD File No-
"I"A002.DW0 1:30'
Drawing Na.
AW2
14 1 15 1 16 1 17 Copyright (c) 20D4 Robert A.M. Stern Architects