Noho Permit App pg 3 SECTION 5- DESCRIPTION OF PROPOSED WORK (check all applicable)
New House
Addition
Replacement Windows
0r Doors
Alteration(s)
Roofing
Accessory Bldg.
Demolition
New Signs [ ] Decks [ ] Siding [ ] Other [ ]
_________________________________________________________________ Brief Description of Proposed
Work:________________________________________________________________________________________
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 _________ Two Family _________ Other __________
b. Number of rooms in each family unit:______________ Number of Bathrooms_____________
c. Is there a garage attached? _________
d. Proposed Square footage of new construction._____________________ Dimensions __________________________________
e. Number of stories? ________________________________
f. Method of heating? ________________________________ Fireplaces or Woodstoves ___________ Number of each ______
g. Energy Conservation Compliance. _____________________ Masscheck Energy Compliance form attached? _______________
h. Type of construction _______________
i. Is construction within 100 ft. of wetlands? ______ Yes ______ No. Is construction within 100 yr. floodplain ______Yes _____No
j. Depth of basement or cellar floor below finished grade __________________________
k. Will building conform to the Building and Zoning regulations? ________ Yes _______ No .
l. 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
I, _______________________________________________________________________________________, 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.
______________________________________________________________________________________________________________
Print Name
______________________________________________________________________________________________________________
Signature of Owner/Agent Date