0011 PARADISE AVENUE - BPA-14-1222 RPR PORCH ~ i�'14 oc'
1 The Commonwealth of Massachusetts
P. 4 i VED
Board of Building Regulations and Standards INSPECTIONA SEf � 1F
Massachusetts State Building Code,780 CMR
Revised filar 2011
Building Permit Application To Construct, Repair, Renovate Or F oh $ A lie 42
One-or Two-Family avelling
This Section For Official Use Only
Building Permit Number: Date Applied:
Building OfNcial(Print Name) Signature Date
SECTION 1:SITE INFORMATION
A Pro erty Address• /� 1.2 Assessors flap& Parcel Numbers
�ara �1S'� Avp, _
I.1 a is this an accepted street?yes Map Number Parcel Nurn her
1.3 Zoning Information: 1.4 Property Dimensions:
Zoning District Propsed Use Lot Area(sq R) Frontage(11)
1.5 Building Setbacks(ft)
Front Yard Side Yards
Rear Yard
Required Provided Required Provided Require) Provided
1.6 Water Supply:(MLO L c.40,§54) 1.7 Flood Zone Information: 1.8 Sewage Disposal System:
Public❑ Private❑ Zone: _ Outside Flood Zone'?Check irycs❑ Municipal❑ On site disposal system El
SECTION 2: PROPERTY OWNERSHIP'
2.1 wne 'of Record: `
�.vr c S r4 P,
N;une(Print) City,State,ZIP
� Ma �� A\) Rl8 ��15 ld5s SaT�ea� 1a�� Z� aGd �
No.and Suet 'telephone Linrtil Address
SECTION 3: DESCRIPTION OF PROPOSED WORK(check all that apply)
New Construction ❑ Existing Building❑ Owner-Occupied ❑ Repairs(s) ❑ 1 Alteration(s) ❑ Addition ❑
Demolition ❑ Accessory Bldg. ❑ Number of Units Other ❑ Specify:
Brief Denscription of Proposerd7Worlk..'':
SECTION 4: ESTIMATED CONSTRUCTION COSTS
Item Estimated Costs: Official U Only
Labor and Materials a Use n
y
I. Building $ I. Building Permit Fee: $ Indicate how fee is determined:
2. Electrical $ ❑Standard City/town Application Fee
❑"rotal Project Cost(Item 6)x multiplier x_
3. Plumbing $ ?, Other Fees: $
4. %lechanical (IIVAC) $ List:
5. Mechanical (Fire
Su ression) $ Total All Fees: $
6. Total Project Cost 5 SOd , e,a Check No. Check Amount: _Cash Arnonnt _
�/ _— ❑ Paid in Full 0 Outstanding Balance Due:
Y
SECTION 5: CONSTRUCTION SERVICES
5.1 Construction Supervisor License(CSL) h
f �t
' - ' +- • License Number Expiration Date
Name or CSL Holder
j ti ,}1 A 8 ; iub MIA List CSI,'rype(see below)
No.and Street Type Description
(1 Unrestricted(Buildings up to 35,000 cu. ft.)
R Restricted 1&2 Family Dwelling
Cityfl'own,State,ZIP M Mason
ry
RC Rooting Covering
WS Window and Siding
SF Solid Fuel Burning Appliances
I Insulation
1'ele hone Email address D Demolition
5.2 Registered Home Improvement Contractor(HIC)
f11C Registration Number Expiration Date
Ii1C Company Name or 1-IIC Registrant Name
No.and Street
Email address
Ci[ frown,State,ZIP Tel- hone
SECTION 6:WORKERS'COMPENSATION INSURANCE AFFIDAVIT(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 building permit.
Signed Affidavit Attached? Yes .......... ❑ No...........11
SECTION 7n: OWNER AUTHORIZATION TO BE COMPLETED WHEN
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: OWNEW OR AUTHORIZED AGENT DECLARATION
By entering my name below, I hereby attest under the pains and penalties of perjury that all of the information
contained in this application is true and accurate to the best of my knowledge and understanding. -
C —5�
Print Owner's or Authorized AgLNtrfs Name(Electronic Signature) Date
NOTES:
I. An Owner who obtains a building permit to do his/her 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
program or guaranty fund under M.G.L.c. 142A.Other important information on the HIC Program can be found at
www.mass.gov/oca Information on the Construction Supervisor License can be found at www.mass.eov/dns
2. When substantial work is planned, provide the information below:
Total floor area(sq. f.) (including-garage, finished basement/attics,decks or porch)
Gross living area(sq. 11.) Habitable room count
Number of fireplaces _ Number of bedrooms _
Number of bathrooms _ Numberofhalf/baths
Type of heating system _ Number of decks/porches_
Type of cooling system_____ Enclosed _____Open
3. "Total Project Square Foolage" may be substituted for"Total Project Cost'