9 LOCUST STREET - BPA 17-97 REDO KITCHEN L'
The Commonwealth of Massachusetts
Board of Building.Regulations and Simdalb P 0 1
Massachusetts State Building Code,
Building Permit Application To Construct,Repair,Renovate Or Demolish a Rev.Sept 2014
One-or Two-Family Dwelling
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1.1 Property Address: 1.2 Assessors Map&~Parcel Numbers
OK e L
A'3�-
1A Is this an accepted street?yes` no Map Number Parcel Number
13 Zoning Information: 1A Property Dimensions:
Zoning District Proposed Use Lot Area(sq ft) Frontage(ft)
15 Building Setbacks(ft)
Front Yard Side Yards Rear Yazd
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 yes❑
2.1 wnerl o ecord: c n
V114 009
Name(Print) City,State,ZIP•
•�
No.and Street Telephone Email Address
New Construction❑ Existing Building❑ Owner-Occupied ❑ Repairs(s) ❑ Alteration(s) ❑ Addition ❑
Demolition ❑ Accessory Bldg.❑ Number of Units Other ❑ Specify:
Briefpescription of Pro o ed Wo k2:
c
Ord
Estimated Costs f
Item (Labor and Materials)
1.Building $ r
2.Electrical $
3.Plumbing $
4.Mechanical (HVAC) $
5.Mechanical (Fire r
Suppression) $
6.Total Project Cost:
dLN
x
5.1 Construction Supervisor License( L)
License Number Y Expiration Date
&Qe'o61f0CSL Holder
List CSL Type(see below)
No.and treet
Unrestricted(Buildin s up to 35,000 cu.ft.)
Restricted 1&2 Family Dwelling
Cityown,State, M Masonry
RC goofing Covering
WS Window and Siding
SF Solid Fuel Burning Appliances
/ G I Insulation
Telephone Email address D Demolition
5.2 Registered Home Im rove ent Co tractor(HIC) f
G HIC Registration Number xpiration Date
ompany Name or HIC Registrant N11me
C4 4
No.and Street Email address
Ci /Town, tate,ZIP Telephone
IOUx
Workers Compensation Insurance affidavit must be completed and submitted with this application. Failure to provide
this affidavit will result in the denial of the Issuance2f_1he building permit.
Signed Affidavit Attached? Yes .......... No...........❑
+d Y.' ,`c^'^ .Sf .:w'•. issue•
I,as Owner of the subject property,hereby authorize_Tle(�O r),QA_ Qn$d�b- I 1 K G'
to act on my behalf,in all matters relative to work authorized by this building permit application.
Print wner's Name(Electronic Si ) Date
M # ng
�.17_.-'. ,
By entering my name below,I hereby attest under the pains and penalties of perjury that all of the information
contained in this a plication is true and accurate to the best of my knowledge and understanding.
11 -/."Xx
Print wn is or Authorize Ag Name(Electronic Signature) Date
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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. ovg /oca Information on the Construction Supervisor License can be found at www.mass. og v/dns
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"