Loading...
BP-91915Aez6le�&l RESIDENTIAL o Phased Approval (R1063.3) $25.00 APPLICATION FEE IS NON ICE-FINI'-DABLE & NON -TRANSFERABLE Contact Person: 40rs 1/. tfi/C�lv, ® RITF' RI Mill 5 Revised 5 /13 CK1Mm#-v mr!mr% 9r RESIDENTIAL 5�11QCV 2 = R6PERT1�<WNkSH1PAtJI HQl6 AGED 1�, ,._ 2.1 Owner Record: mfiaK /1t AS�iy 55t'� ,rSS�aciL� Cerhw ®dam, ��l- i 3 Z Name (print) Contact Address Phone Number 2.2 Authorized Agent: / L-*AS ✓• p Name (print) ContacfAddres''s Phone Number 3.1 Licensed Construction Supervisor/Specialty License: License Number: Company Name/Contractor Name: Address: " 66& Expiration Date: Signature: Telephone: 3.2 Homeowner Exemption - One & Two Family Only Section I IO.R5.1.3.1 Exception: FOR HOMEOWNERS WHO INTEND TO PERFORM AND BE RESPONSIBLE FOR THEIR OWN PROJECT Exception: Any Homeowner performing work for which a Building Permit is required shall be exempt from the provisions of this section; provides that if a Homeowner engages a person(s) for hire to do such work, that such Homeowner shall act as supervisor. For the purposes of this section only, a'Homeowner" is defined as follows: Person(s) who owns a parcel of 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. If you are applying under this section sign below: Signature: ,' � ,- � ,� .; � � '��.��'ION: � YifOF�KEK.�_Q ENS' T �15f ti�tS:1Jt�ATi•-E r�F'FI�A� M�il�;r�fi52" 25 �"s< w �- ` � =.� ',�,,. Worker's Compensation Insurance Affidavit must be completed and submitted with this application. Failure to vide this in the denial the issuance Yes ❑ No affidavit will result of of the building permit. Signed Affidavit Attached: ❑ Deck ❑ Pool ❑ Repairs ❑ Alteration ❑ Chimney/Fireplace ❑ Woodstove/Pellet Stove ❑ New Construction* ❑ Accessory Bldg. ❑ Addition ❑ Roofing/Siding ❑ Replacement window/door (Energy report required) (Shed/Garage) (Energy report required) No. of windows_ Doors_ ® DEMOLITION (specify): tCwQ"H Omc&l) 61 e F back- 8l Gleaff f '/6r 66011J 4l Location of debris removal (per MGL C.40 Sec 54): 0?1[ umpster on site ❑ Dumpster On Street Facility Name: �CS PlSpOSca � Location: /yCr.✓�� *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- fS,,- d 0 Hot Water: G%V • - _ Electric Fuel Oil Other fr. „ z SEGTIQN 6 �STII(11A►t'raQ �!#O T ` _STttTl . ;. - �.Y 4,.`- K., L��3. Item Estimated Cost ($) to be completed by permit applicant 1. Building 2. Electrical 3. Plumbing 4. Mechanical (HVAC) 5. Total= 0 +2+3+4) i©V� ,l=C(QF�tE1ACTFtTi{Q�1 t _ y{ir3he_�a�ls7ete�,rt��iihe� orb[?;�r��_agesl�tsr-�gria��`or;�p fie�,'harl�utldt�peFmtt� _ .__� . (Please Print) I, , 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. Signature of Owner Date $EGTI.ON 7B WNE_17/AU�HO914,MAGENT 150LARAt ON . 19`51/Y 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. 324 /9 Signature of Owner/Authorized Agent Dat— e 4 -CTON $ Qlf=kCEt1C LF-% A,F - Less Application Fee: $25.00 Remaining Balance: $ Total Permit Fee: $ /Sv , Other $ Amount $ Gross Area - New Construction total sq. ft. J Gross Area - Alteration total sq. ft. ' 0, _ ►►, __ __ • e�, Permit Issued to: irp I•Rx"7�t'L?U T��.�, ,_l �I�TE.ISE� tt. .�.�SVPUYi� -.t ,..t _ - +Ji EV: S'�-•'T�Ffr _ti 1 . , 3m-gf GW*9A� BEDROOM LIBRARY HE 1100R PLAN 3CAlE3lD"=PA' Nkw .- LAutiCFY ,rN hJDE,�I N7D°^Oy — � i 1 S 111• - _ .I � BATH i i FI- € y CHEN 1 � U� HALL— vV'vV1 i F-f?CN I i 11 V�v I�rt�e W:I[c arwlcFW.wlfmn AYa wxlal A.. Fq:u L�mv: ff�l l gIYFF M NI rN tY1 fbl RweAWWIf[F[tltlL Pk •1111Ap95d 116RVAYRWaT.[C Yt fAiSSsYF tlFB3 RI 1 rwW�greaWlawn wu.nm Yv Dtll AAI d vapryl Cw wYmJ043KlttxF Ylr.,xWW f4EYM[r�Sgl Y'IW:I fnI w.P1:21➢nQ'yN rftii=.nW �fmmc. a11cI11aFaa[cYl rwY9 Yw MFABrI S YYi IN: FilM[ ry Ell AS 1:3F12:JtfFla LYF-fJIY1R ZN 'Ell ramxn W IxNAF[Luaniasat fY) � • / i ���7/�r VAS fC/•/ neo.nsrflrslavueeum�a uaFro-n AtlAnur:ermnnpw;ea:•., Yurymeat �IAILFS rk'IA:tS FNk�'♦)lµyW Cd111Y:IWA St��ll �ItJ9 3griR4t!R F9A[Lbp YN141AOAl.AfigdFAdfOtASAY urcpel4rcrs11c rlrmuT:arafwoLrtFt� ,furwsarnnaat / "I _`.. � � �I�� � �vcn ulslwl�Yau[RaLaYe•mtlra mx.:n[x. FwA[euuteswvc+xaeays warr-nm.�m INF�1�* xW + /� �� ./ jE � ��� '� Y1 11:RN[illA[IN"FNlIW'Ef(Y. [[VIRtAEe/WIS AIOeNL4l Wiltltfb'pFliw ii wLMY:t l4-wdf,4, boi Cry b"aZL4 No Az . • INOEES f,I I ni ► Kdk CteA Mal 6 V i I� - I VL40 k4te — s 41C ' (n1 V l A �7Nt� CA FIRST FLOOR PLAN SCAEE:A$NOifa BRA t:E11R JB tc �1 � a JOB ib_IB-14 f151 DATE V4/2019 architecture- inleriars 11 (t— EXISING FIRST FLODR PLAN SCAL> slTls �K�s�llN& D)"9ws x�' = �o S r %ol RDDMX .81•$T�i W HALL mi N� EXISTING FIRST FLOOR PLAN E teaowtic - .0 mop - DINING / LIVING I p .G EXISTING FIRST BOOR PLAN SUMAr4f �F U � .."Mot. M"", I.R KF.. 6YRNIALMfGTpNSW XOfWBSEXId W, X I- .. .1. 14 T-11 CA Mml—RUMXAS MF --KA —ERAMNII3 "t.—D R­RAIfV-j NOTES MSRNB WALLS ofmauflm NEW C94STRUCUN C> DDUR MARKER WINOWMARKER FLumm nxTuRF MARKER KOHN DATE EXISTING MOTIONS FIRST FLOGR PLAN SG0:ASNDff9 DRAWN 61814 MJR JOB V EX101 NICHE orchitecture - interiors MATTINICHEARCOM 500253,4160 -V WWWPEAR c CIM FIRST KOUR PIAN NOTES LEGEND EMsnxc wars OENoIInBN NEW co"EmN ERROR MARKER wiNnowmARKiR MUMBtNG WERE MARKER I GFS'Nlflflflh J DATE Sqx,Kl-,C FLOOR PLAN 2J2.16 REAZILDORPLAN 12,24.19 S R.W PLAN I 12.311B 4 REW3EI FLOOR PLAN 1,4.19 FIRST FLOOR PLAN SCALE. AS NEED DRAWN BY: MIA A101 1 8 No DB-g - CATE, W/mg NICHE architecture - interiors MATTiCHEME.EGM 508158.410 WWWNIEFEA C.Com