BP-88764William Whalen
14 Winston lane -
Contact Address Phone Number
arne (print)
2.2 Authorized Agent: 508-509-7584
Woodby R, P, Valois 29 Russells Mills
Michael
Warne _(print) Contact Address Phone Number
EWE
291Russells Mills Road Expiration Date:
Address:
Signature: Telephone: 508-50094584
FOR HOMEOWNERS WHO INTEND TO PERFORM AND BE RESPONSIBLE FOR THEIR OWN PROJECT
Exception: Any Homeowner peftming work for which a Building Permit is required shall be extimpt frdm 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 of this section billy, a 'Homeowner" is defined as follows: Person(s) who owns a parcel of land on which helshe resides or intends to reside, on which
than
purposes
there is, of 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
one home in a two-year period shall not be considered a Homeowner.
if you are applying under this Section sign below:
40
Worker's 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: 0 Yes 0 No
7- ion
• Deck 0 Pool 0 Repairs 12 Alteration 0 Chimney/Fireplace Q Woodstove/Pellet Stave
• New Construction* 0 Accessory Bldg. Q Addition 0 Roofing/Siding (I Replacement windoW/door
No. of windows 2 Doors
(Energy report required) (Shed/Garage) (Energy report required)
Local ion, of debris removal (per MGL C.40 Sec 54): [ji Dumpster on site [I Dumpster On Street
"If new construction, please cUmplete the following:
Single Family- No. of Bedrooms No, of Baths
Two Fpmlly: No of Bedrooms Unit I No. of Baths Unit I
No of Bedrooms Unit 2 No. of Baths Unit 2
0 Furnace (hot air) - fuel gas (natural or propane), fuel oil, electricity, other (specify):
0 Boiler (heating) - fuel gas (natural or propane), fuel oil, electricity, other (specify):
0 HVAQ (cornboned unit) - primary fuel, natural gas, propane, electricity, other (specify):
OAir conditioning - (separate unit)
ONone of the above toboprovided
�emh Fuel mnn
OHm»V�e�_-���_---___._- «---------- ---------- --___---__
1, Building
2. Electrical
3. Plumbing
Print)
1, Bill Whalen
to act on my t�eh* in all
�timated Cost to be com
)00.00
100.00
ft
as Owner of the subject property hereby authorize R. p. ValolsNichael Wc-)odby
relative to Work authorized by this building permit application.
5C24/ 8
Signature `" Owner
. �
WN
Michael-WoOd Y R. P. Valois as Owner/Authorized Agent hereby declare that the statements arid Information
1, te, to the best of MY knowledge and belief
on the foregoing application are true and accura
Signed ~ 5�4 18
Date
QroeArea ' New 0on8trUctiototal sq. ft.
Gross Ama-Alton
permit Issued to:
As the |an� and
nmnv��ex��n0k�chencab�eUaamJnapmn»Qmu'"�=°""^y~~~-'' vvorkieinuobih��y.8onrb\xa
construction windows. �m���me
r-are
.�one door Way and \nutoU�Qtwo na»vandv»mUd"'UVt���`~�th�extehor ofthe house.
----~o\unnbinQandpm\nUng.Thedoonway v ".^ _
,1ESIDENTIAL ❑ Phased Approval (R106.3.3)
Cgs_on APP1,16 ATION FEE IS NON RE-7UNtII LE & NON -TRANSFERABLE
1.1 Property Add ress: 14 Winston lane
Contact Person: Michael Woodby
Phone Number: 508-509-i 584
1.4 Water Supply (MGL c40 s54): 1.5 80�*dge Disposal System:
® Municipal M Municipal
❑ Private Well ❑ On Site Disposal System
1.2 Assessors Ma &Lot Number:
3�
Map — Lot
1.3 Historical District ❑ Yes 11 No
Year 13ilf€ 2000
❑ Altering more than 25% per side of building
Has application been submitted to the Historic Commi%sion ?
Yes D(No Lute:
Reviserri 5 /13
rl r'nN.RTRHr.T10N PLANS 0 SITE PLAN ❑ ENERGY RFPnRT