TOWN OF ARLINGTON
	51 GROVE STREET
	ARLINGTON, MASSACHUSETTS  02476
	APPLICATION FOR PERMIT TO BUILD

				Date:   20
To the: INSPECTOR OF BUILDINGS: The undersigned hereby apply for a permit to { alter / build } according to the following specifications and the plans filed herewith:
1.	Street and No.				Lot No.
2.	Owner			Address
3.	Architect			Address
4.	Builder			Address
5.	Class of Construction			Material
	Zoning
		DESCRIPTION OF PROPOSED CONSTRUCTION
6.	Size of Lot	front	rear	depth	Area sq. ft.
7.	Size of Building	front	rear	depth	Area sq. ft.
8.	Distance from Street
9.	Distance from lot Lines	side (left)		rear	side (right)
10.	Number of Stories			Height in Feet
11.	Foundation on Filled Land			Yes	No
12.	Foundation Material			thickness   depth   mortar
13.	Roof Truss Construction			Yes	No
14.	Duplicate Plans			Plot Plan
15.	Estimated Cost
	CONSTRUCTION AND PLOT PLANS IN DUPLICATE MUST BE SUBMITTED TO AND APPROVED BY THIS DEPARTMENT BEFORE A PERMIT WILL BE GRANTED
	The applicant shall locate proposed building with due regard to lines, grades and sewer location obtained from the Town Engineer.
I hereby certify that the dimensions and other information on the plans are correct and that all applicable provisions of Statutes, Regulations and By-Laws will be complied with.  The above is subscribed to and executed by me under the penalties of perjury in accordance with Section 1-A of Chapter 268, General Laws.
Tel No.		Owner's Signature
Tel No.		Builder's Signature
		License No.
		Home Improvement Contractor Reg. No.