HomeMy WebLinkAboutMiscellaneous - 171 LIBERTY STREET 4/30/2018 (2) _ (np OqNEDIS-1
p oo M9 f.i v 21apPo� self -,;Il
i-ld 3SV a DE)dSSDw
NOISN31X3 J3BWf1N X000 VDCV
Iwo HnoYb7 ../15 alieo}s.� SNOHd
Q xVd❑
GO w
Ls v-P!7S W ll DJ-V CIt10_-j
� A�M1�►,�ti93/NM ilOA�'i I H/U
�_ 7-_
PIP
FOR /�Lf.foyt +OATE7 TIME
M
�y-� PHONED
OF � .Srkg?-�
FAXRETURNED
�h Q I
PHONE ❑M021LE -Gjq- l /O YOUR GALL
AREA CODE NUMBER EXTE,N"SION
MESSAGE • �4S %h -7-6 S610 OU ,VdT PLEASE GALL
1NILL,CALL
oh,</ ,l //S�-id / /
5/ �e V/cS��� +• �T� �S 6� Gr�Y�/�i SEE YOU
TO
YOU
SIGNED � OM FORM 4002
f
-
' - — - --- au -ai o y-- - - - ------
tT
Add (OA)
U - LOT RELEASE
INS : This form is used.to Verify that ail-necessary approval!permits from
Boards and Departments having jurisdiction have been obtained. This does not relieve the
applicant and or landowner from comp a with any applicable requirements.
�..........e.....rs..s�.ar...a■ -.: ...s...u.s...s.0awwwwwwwMa.w.........r.....a
APPLICANT - </ �,r-,. PHONE 7E-(--
ASSESSORS
-(-ASSESSORS MAP NWMER .�4 C ,r3 LOT NiT111BER
SUBDIVISION LOT NUMBER
STREET I3 ry
......... STREET NUMBER
....................... ..-..-.........................- ..........
F OFFICIAL USE ONLY
RECOhIMENDATIONS OF TOWN AGENTS
@OWN --.■ -------.-.--...a-.a---- ------- ---------a.--r------------ -.--
r-.-a. -■
DATE APPROVED Q
CONSERVATION AD TRATOR
DATE REJECTED
CONIIy1ENTS hl21b (C,4�m re-AIM4,J Jo A in r 1�, ?roocse"I au{s Je. k
Ae. FicAr, wof_ u-r a -GI dcZ�i c7 ra��ih
s
DATE APPROVED
TOWN PLANNER
DATE REJECTED
CON RVII NTS
DATE APPROVED
FOOD INSPECTOR-ITFALTH DATE REJECTED
------------
DATE APPROVED
SEPTIC INSPECTOR-HEALTH
DATE REJECTED
COMMENTS
PUBLIC WORKS SEWER!WATER CONFECTIONS
DRIVEWAY PERMIT
DATE APPROVED
FIRE DEPARTMENT
DATE REJECTED
COMMENTS
RECEIVED BY BUILDING INSPECTOR -
DATE
4
T
SECTION 4-WORKERS COMPENSATION(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 buildinE permit.
Signed affidavit Attached Yes.......❑ No.......❑
SECTION 5 Description of Proposed Work check alta Hcable
New Construction &1' Existing Building ❑ Repair(s) ❑ Alterations(s) ❑ 1 Addition
Accessory Bldg. ❑ Demolition ❑ Other ❑ Specify
Brief Description of Proposed Work:
X.� &�Jh= MA C77®.0 r,'( j �.2 13
SECTION 6-ESTIMATED CONSTRUCTION COSTS
Item Estimated Cost(Dollar)to be C}FPIICIAI:ITSEf}NI�' �r
Completed by permit applicant
1. Building lao,orto ^/6a�0c6 (a) Building Permit Fee
Multiplier
2 Electrical (b) Estimated Total Cost of
Construction '
3 Plumbin -=AaBuilding Permit fee(.a>X (b)
4 MechanicalHVAC) 1-X'ewZ7
5 Fire Protection
6 Total' 1+2+3+4+5 /' Check Number
SECTION 7a OWNER AUTHORIZATION TO RE COMPLETED WHEN
OWNERS AGENT OR CONTRACTOR APPLIES FOR BUILDING PERMIT
I as Owner/Authorized Agent of 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
SE_CTTI.•O�N.7b, OWNER/AUTHORIZED AGENT DECLARATION
I, -"-mag rear-t �f�U4 as Ovmer/Authorized Agent of subject
property
Hereby declare that the statements and information on the foregoing application are true and accurate,to the best of my knowledge
and belief
1 �
Print alne
Si 3paVire of caner/A ent Date
NO. STORIES SIZE
-
ASEMEDR SLAB
S DOR TIMBERS --;-Xi J 15 2 D 3
SPAN
DIMENSIONS OF SILLS �� )
DIMENSIONS OF POSTS
DIMENSIONS OF GRtDERS_
HEIGHT OF FOUNDATION THICKNESS "
SIZE OF FOOTING
MATERIAL OF CFLNINEY ,caul
IS BUILDING ON SOLID OR FT—1 LAND
IS BUaDTNG CONNECTED TO NATILTRA1,GAS LINE --Jtpd --
T
'oi l fltl
/3/.
j
- \.^
_ / y (, � • 1
g ,
\ 1
41
—a , y .
% \ .
. yi f
\ ! ,. s
�'
Aj
10
f
-
\
,
l
�` `� ` 1 r '' .tea'-""�•� �� ,.- ,( ---f
"
Al
99' Oj