26 OAKLAND ST - BPA 1'he Commonwealth of Massachusetts --
`� ,1 Board of Building Regulations and Standar CTlt"'L S RV1 L M
2( 1a SPE s,\Lent
?), , Massachusetts State Building Code, 780 CMR R t.i,. Ilur 2011
L 1�
Building Permit Application To Construct, Repair, Renovate(af1f�tEtPlf�hla
Our-or Two-Family Dwelling LLBB
This Section For Ot ial Use Onl
Building Permit Number: ate
AApplilied:
building Otrcial(Print Name) Signature Date
SECT VON 1: SITE INFORMATI
1.1 Propert Add ess: �/ / 1.2 Assessors Map& Parcel Numbers
I.I a Is this an accepted street?yes_ no Map Number Parcel Number
1.3 Zoning Information: 1.4 Property Dimensions:
Zoning District Proposed Use Lot Area(sq tt) Frontage In)
1.5 Building Setbacks(ft)
Front Yard Side Yards Rear Yard
Required Provided Required Provided Required Provided
1.6 Water Supply: (M.G.L c.40.§54) 1.7 Flood Zone Information: 1.8 Sewage Disposal System:
Zone: _ Outside Flood Zone? Municipal❑ On site disposal s stem ❑
Public❑ Private❑ Check if yes❑ P P )'.
SECTION 2: PROPERTY OWNERSHIP'
2.1 O 10 ecor
Name(Print) �` City,State,l.IP
No.and Stree Telephone Email Address
SECTION 3: DESCRIPTION OF PROPOSED WORK'(check all that apply)
New Construction❑ Existing Building❑ Owner-Occupied ❑ 1 Repairs(s) ❑ Alteration(s) ❑ Addition ❑
Demolition ❑ Accessory Bldg. ❑ Number of Units_ Other ❑ Specify:
Brief Description of Proposed Work':
SECTION 4: ESTIMATED CONSTRUCTION COSTS
Item Estimated Costs: Official Use Only
Labor and Materials)
I. Building S I. Building Permit Fee: S Indicate how fee is determined:
❑Standard City/Town Application Fee
2. Electrical S �
❑Total Project Cost (Item 6)x multiplier %
i, Plumbing S 2. Other Fees: S
4, \Icchanical (IIVAC) S List:
S. \lechanical 'Fire S Total :\II Fees: S
Su rcssionl
Check No. Check Amount: --Cash Amount____
G. Total Project Cost: �� ❑Paid in Full 0 Outstanding Balance Due: ___ -----
_
f
SECTION 5: CONSTRUCTION SERVICES
5,1 Con ction �ppervisor Licen. L)
_— _ — License umber lispirali w Uatc
N:unc of C'SI. I Inl
_C P List CSL'type(See helow)
No, and Strccl Description
po S Ll I Inrestricted I I uildin�s tit to 35,000 cu. It.)
C'i y! own.,lute,ZIP Restricted 1&2 Famil Dwellin.
M Mason
RC Roolin I C'o%crin
W'S Window and Sid-
G/ SF Solid Fuel Burning Appliances
(( �� I Insulation
"I' I hone @mail address D Demolition
5.2 Registered one ytro nlent Co tractor IC)
MCC C tp' at c t at I ✓✓OO ant Nam ` HIC I cgislration Number If. pirnionDate
g�
Nu. trod
/i) n > /lO L Finail address
City/Town,State,ZIP �/-d Telc�hone
SECTION 6:WORKERS'COMPENSATION INSURANCE AFFIDAVIT(M.G.L.c. 152. 1 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 building permit.
Signed Affidavit Attached? Yes .......... ❑ No........... ❑
SECTION 7a: OWNER AUTHORIZATION TO BE COMPLETED WNEN
OWNER'S 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,
Print Owner's Name(Electronic Signature) Date
SECTION 7b:OWNER' OR AUTHORIZED AGENT DECLARATION
By entering my name below, I hereby attest under the pains and penalties of perjury that all of the information
contain d in this application is tt nd accurate best of my knowledge and understanding.
J hca __f
Ix I not Owner s or Authorized Agents Name(I:Iectronle Signature) Date
NOTES:
F2. Ahen
n Owner who obtains a building permit to do his,ber own work,or an owner who hires an unregistered contractor
not registered in the Home Improvement Contractor(HIC)Program),will not have access to the arbitration
rogram or guaranty fund under M.G.L.c. 142A.Other important information on the HIC Program can be found at
��o:iIl;)p,.g;ov nett Information on the Construction Supervisor License can be found at w o,to,nrtS..�,n ,Ips
substantial work is planned, provide the intormation below:
Boor area(sq. B.) __(including garage, finished basementattics,decks or porch)
living area(sq. It.) Habitable room count
Number of fireplaces---------_ Number of bedrooms ----------
Number-of bathrooms ____----___---- Numberofhalfbaths ---------
1)pe of heating System --
Number of decks, porches_
F%pe of cooling Ss Stem -- -----------
_ _...-- ------------------- Inclosed _-------Open
3. ' rolal Project Square Footage-niay be substituted for•'total Project Cost,,