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14 PICKMAN RD - BUILDING INSPECTION (2) t The Commonwealth of Massachusetts Board of Building Regulations and Standards i CITY ^ Massachusetts State Building Code,780 CMR 7" edition g v sr ed anuary \ Building Permit Application To Construct,Repair Renovate Or Demoli a I, 2008 j One or Two Family Dwelling „$ifil¢rngPerinitNumber _' t'�81g^�X�pL{e 1`�i - Signature $: ding Corrimiss ner7 dxofjj¢£$ip m)s ale 1.1 Prope . ddry� /�� 1.2 AssessorsvAap&Parcel Numbers L l 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(sg11) - Frontage(11) 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 system ❑ public -Private❑ Check if yes❑ 5CxiONi,yPR© E :_. 1fiisHt1+' 2.1 Owneri of Record Name(Pont Address for Service: 10 v /LJ�r/ � a e,X, 2!> Signature Telephone Sk_T.,0, I3 DESC"RIPPC >�JV44XPV2�& ='WORK jclteckallthatapply) New Construction❑ Existing Building❑ Owner-Occupied ❑ Repairs(s) ❑ Alteration(s) El Addition ❑ Demolition ❑ Accessory Bldg. ❑ Number of Units_ I Other ❑ Specify: Brief Description of Proposed Work` o d C 011 v. SECTION 4:ESTIiYIA7I I1 COk�fSTRU I JON COS I S Item Estimated Costs: - [;:official=Use Duly Labor and Materials L Building $ 1 Building Perrpit Fee $�, Indicate how fee is determined: [75tandard Crtj/T6xV7iApp1lcati0n-Fee 2.Electrical $ D To rg � Vs---O x rtSWhplier x 3.Plumbingre - $ �resf _ 4.Mechanical (HVAC) $ 5.Mechanical (Fire Total✓�1lFes $ Suppression) Cheek 1 Ib: Cligck Amount: Cash Amount: 6.Total Project Cost: $ '3 2 Q�. `ClrPmd to ull ❑ Outstanding Balance Due:.. SECTIONS CC1N$IRIX4 11RVICS 5.1 Licensed Construction Supervisor(CSL)' o�— M7 Q L `\�io�� License Number Expiration Date Name of CSL-Holder List CSL Type(see below) y r pvr't ww� Lai�� t, ,:, Address 2 x ,�. ,�• ' 'gsbri tiara- , U Unrestricted u to 35,000 Cu.Ft. �GtiL' R Restricted 1&2 Family Dwelling Signs: pp� M MasonryOnly 6 -7�:-7 �/.S b� 13 i RC Residential Roofing Covering Telephone WS. Residential Window and Siding SF Residential Solid Fuel Burning Appliance Installation. D Residential Demolition 5.2 Re 'stere H e I proveme/nrt Coutragt r IC) �� 61 S y _ HIC Co�D�� Name or MC Regrtb 1e L. Registration Number Address Expiration Date Signature J�r f Telepne SECTION 6 WORKERS+COMPENSAITpN IN IIRANCE AFFIIIAVIT:(M:G.L.c. 152.§ 25C(6)) Workers Compensation Insurance affidavit musvbe pleted`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.0�F NER ACJ 1 ti(�)2It e*TIdN; gi, BE,L 1tL E�V4 HEN OW3sFER'S AGENT.I 4L oNT-RAC 1bR APP S Foil.`.ill NIs PERMTI I /U L / �^ el as Owner of the subject property hereby authorize to act on my behalf,in all matters relative to work authorized by this buil g ep rmit application. Si afore of Owner Date SECToN,71i„Oi t0 . T)2aG1(5 I-3 CL tRAzT30N, as Owner or Authorized Agent hereby declare that the statements and information-on the foregoing application are true and accurate,to the best of my knowledge and behalf. L Print Name A � i beSignature of Owner or Authorized Aggut Date I Si ned !the,sins and enalties of edu .•. . N,aa 1. An Owner who obtains a building permit to do his/her own work,or an owner who hires an u M nregistered 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 and Construction Supervisor Licensing(CSL)can be found in 780 CMR Regulations 110.R6 and 110.115,respectively. 2. When substantial work is planned,provide the information below: Total floors area(Sq.Ft.) (including garage,finished basement/attics,decks or porch) Gross living area(Sq.Ft.) Habitable room count Number of fireplaces Number of bedrooms Number of bathrooms Number of half/baths Type of heating system Number of decks/porches Type ofcooling system Enclosed Open 3. "Total Project Square Footage"may be substituted for"Total Project Cosy'