36-365 (2) 'M4 - s
SECTION 5-DESCRIPTION OF PROPOSED WORK(check all applicable)
New House Addition ❑ Replacement Windows Alterations) ❑ Roofing ❑
Or Doors D
Accessory Bldg. ❑ Demolition ❑ New Signs [0] Decks [M Siding [01 Other IQ
Brief Description of Proposed
Work: CONSTRUCT TWO-STORY SINGLE FAMILY RESIDENCE WITH TWO-CAR GARAGE
Alteration of existing bedroom Yes No Adding new bedroom Yes No
Attached Narrative Renovating unfinished basement Yes No
Plans Attached Roll -Sheet
6a.If New house and or addition to existing housing, complete the following:
a. Use of building : One Family V Two Family Other
b. Number of rooms in each family unit: 7 Number of Bathrooms 2-1/2
c. Is there a garage attached? yes
d. Proposed Square footage of new construction. 1,957 Dimensions 52' x 52'
e. Number of stories? I
DUCTED FORCED HOT AIR (natural gas)
f. Method of heating? Fireplaces or oodstoves GAS FP Number of each 1
g. Energy Conservation Compliance. HERS Masscheck Energy Compliance form attached? YES
h. Type of construction WOOD-FRAMED
i. Is construction within 100 ft. of wetlands? Yes V No. Is construction within 100 yr. floodplain Yes VNo
j. Depth of basement or cellar floor below finished grade 81
k. Will building conform to the Building and Zoning regulations? _Yes No .
I. Septic Tank City Sewer�� Private well City water Supply _
SECTION 7a-OWNER AUTHORIZATION-TO BE COMPLETED WHEN
OWNERS AGENT OR CONTRACTOR APPLIES FOR BUILDING PERMIT
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
ROSEMUND, LLC - GREG QUILL 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.
GREG QUILL
Print Name
06-09-20
Signature of Owner/A9 �t Date