BP APP 17-66 @ 18 ROPES STREET 2L M9 [Li:�D tis--a
7 , .�.t:
�. The Commonwealth of Massachusetts
Board of Building Regulations and Standards CITY OF
Massachusetts State Building Code,780 CMR 1 l�e�!��20T1( ' 0 2
Building Permit Application To Construct, Repair, Renovate Or Demolish a
One-or Two-Family Dwelling
� This Section For Official Use Only
Building Permit Number: Date pplied:
f Building Official(Print Name) Signature Date
SECTION 1:SITE INFORMATION
1.1 Property hAddress:
ip �j _ 1.2 Assessors Map&Parcel Numbers
L la 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 ft) Frontage(ft)
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:
Public❑ Private❑ Zone: , Outside Flood Zone? Municipal& On site disposal system ❑
Check if yesO
SECTION 2: PROPERTY OWNERSHIP'
2.1 Owner'of Record: Ri
Name(Print) City,State,ZIP
*-9-L*-9-L06 V;�4as S�_ ! 611 t34 4369
No.and Street I Telephone Email Address
SECTION 3:DESCRIPTION OF PROPOSED WOW(check all that apply)
New Construction❑ Existing Building❑ Owner-Occupied ❑ 1 Repairs(s) ❑ 1 Alteration(s) 29 1 Addition ❑
Demolition ❑ Accessory Bldg. ❑ Number of Units I Other ❑ Specify:
Bef,Description of Proposed Work 2: r L S
I (�Z 1�ce-
T; f�lce
SECTION 4:ESTIMATED CONSTRUCTION COSTS
Item Estimated Costs: Official Use Only
Labor and Materials
1.Building $ 1. Building Permit Fee: $ Indicate how fee is determined:
2.Electrical $ ❑Standard City/Town Application Fee
❑Total Project Cost'(Item 6)x multiplier x
3.Plumbing $ 2. Other Fees: $ We)4.Mechanical (HVAC) $ List:
5.Mechanical (Fire $
Su ression Total All Fees: $
Z
Check No. Check Amount: Cash Amount:
6.Total Project Cost: $ O i �SOO ❑Paid in Full ❑Outstanding Balance Due:
�>.� Ct'L I - 375 -7- ("6'j 3
SECTION 5: CONSTRUCTION SERVICES
5.1 �
Construction Supervisor License(CSL)
(� License Number Expiration Date
' Name of CSL Holder V
� J List CSL Type(see below)
MG— NS 6
No.and Street `�—, Type Description
Unrestricted(Buildings u 000 cu.ft.
R
1 dam_ I I R Restricted 1&2 FamilyDwelling
Cityfr wn,State,ZIP M Masonry
RC Roofing Covering
WS Window and Siding
�X.J`T SF Solid Fuel Burning Appliances
CXJ I Insulation
Telephone Email address D Demolition
5.2 Registered Home Imzwc roveme t Contractpr(VIC)
HIC Registrati:ZC0
Nu
Expiration Date
HI��oGpa6�arp �r �, Registrant Name v t �c
j� -}�, � ' r� u( i(\1
N t o,Nrfteltla r�N f1 i(,1�� ��� ZG_, 13 Email address
Ci /Town,State,ZIP V 1 Telephone
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..........9 No...........El
SECTION 7a:OWNER AUTHORIZATION TO BE COMPLETED WHEN
OWNER'S AGENT OR CONTRACTOR AP1PLIES FOR PERMIT'
I,as Owner of the subject property,hereby authorize I t'� i(n�
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 th 'ns and penalties of perjury that all of the information
contained in this application is true And accurate h e o y knowledge and understanding.
0,4/17
Print Owner's or Authorized Agent's Name(Ele trop' igna Date
OTES:
1. 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�dps
2. When substantial work is planned,provide the information below:
Total floor 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 of cooling system Enclosed Open
3. "Total Project Square Footage"may be substituted for"Total Project Cost"