3 BARR ST - BPA-11-541 RPR DAMAGE TO KITCHEN AREA I The Commonwealth of Massachusetts
Board of Building Regulations and Standards CITY
Massachusetts State Building Code, 780 CMR,7"edition SALEM
R O sed Jan Mn_
Building Permit Application To Construct, Repair,Renovate Or Demolish a 1, 2008
One-or Two-Family Dwelling
,,°..This Section For Official Use Only
Building PetmitNum r:. ::'' Date:A(Spli is
Signature:
Building Commissioner, Spector of Buddr = zDate
1 ".`SECTIO 1:SITKINFORMATION ,k
1.1 Property Addresssf ' (ti_ '(� 1.2 Assessors Map&Parcel Numbers
LI 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 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 a 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❑
1 2- h ", SECTION 2 `rPROPERTY OWNERSIIIPr;r -
2.1 Owner'of Record:
)e46.sLJ^Q✓ IS xf
Name(Pruitt, Address for Service:
�o� d� J1It
,SigBatur „ Telephone
SECTIQN 3 DESCRIPTIO OF PROPOSED WORK_(check all that apply)
New Construction❑ Existing Building Owner-Occupied ❑ Repairs(s) Alterations) ❑ Addition ❑
Demolition Accessory Bldg. ❑ Number of Units Other ❑ Specify:
Brief Description of Proposed Work 2: re ,n S7 ,
r` GL'�.�ll_ ✓��9!-a las I'-O�C�� 'j luM1 �i � (�lr c'1- Zc1 1-u h �
Q.t9irt n�a,,.r ,.14�+
' SECT' '41.4STIMATED CONSTRUCTION COSTS {a g
Estimated COSTS: i R , �
Item "� « Official:Use Only, ,
(Labor i._
L Building $ � 7 4 7 0�. 1 Building Permit Fee $ Indicate how fee is determined::-
2.Electrical $ Cl \,I. i j13Standard Crty/Iown Application Fee. €
O Toial Project Cost'pte_m 6)x multiplier .= x
3.Plumbing $
4.Mechanical (HVAC) $
/,//4
5.Mechanical (Fire $
Suppression)
Totai All Fees $
s
oG Check No 3 'Z Check Aoinuit Amountir
6. Total Project Cost: $ LAI' 07iL7 ❑para in Full= t ;[ ❑Ou[sjandtng Balapce Due. .:
SECTION 5: CONSTRUCTION SERVICES
5.1 Licensed Construction Supervisor(CSL)
A
6h4 W.1 / "/✓P`J License Numbero� Fa pimtion Date
Name of CSL-Holder Lr
3 List CSL Type(see below)
�G "//Z< A,�?a 1 �? ' �/,a f-/4,,°f
Address o(166 !-,'Type," •� = ,De ri tioh "
U Unrestricted �to 35,000 Cu.Ft.
Signahtre R Restricted 1&2 Family Dwelling
M Masonry Only
Telephone RC Residential Roofing Coveting
WS Residential Window and Sidin
SF Residential Solid Fuel Burning Appliance Installation
D Residential Demolition
5.2 Registered Home Improvement Contractor(RIC)
r c7z t u,,,5{ r �ci,y.t tun es inn-w� T I�3a99
HIC Company Name or HIC Registrant Name Registration Number
Addres I � ( �1'-I f�Gi'oL
Expiration Date
'gnature Telephone
:.SECTION 6 WORKERS'COMPENSATION INSURANCE AFFIDAVIT(M G 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__........❑
SECTION 7a:OWNER AUT$ORIZATtON`T6 BE COMPLETED'WHEN `4
OWNER'SXGENT`ORCONTRACTORAPPI;IE5FORtu", VGPERMTI
I, ✓t y as Owner of the subject property hereby
authorize ll�. ��, (Lj x s(, - { ,v.I to act on my behalf,in all matters
relative to work authorized by this building permit application.
Si9fiature'ofOwner
SECTION 7b:OWNEBi,OR AUTHORIZED AGENT DECLARATION
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
(3hpt,).!, A
PrintN�ame� 21
..--,_.... . . a(- 2a ,201 y
Signature of Owner or Att�d Agent Date
(Signed under the pains acrd enalties of In
NOTES
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 and
Construction Supervisor Licensing(CSL)can be found in 780 CMR Regulations 110.R6 and 110,R5,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 3
Number of bathrooms Number ofhaWbaths t
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"
llCU-Z4-LU1U 12:34 NDIC FACULTY 202 231 2171 P.002
2/2
2. Written change orders or Orders for minor changes in the Wolk issued after exceution of this
Agreement must be in writing and authorized by owner or owners authorized representative.
3.Other documents,if any,identified as follows:
5)Certificate of Insurance-Pride Construction and Development,Inc,insurance
Company Policy Number Copy attached or to be delivered no later
than 7 business days of contract execution
b)MC License-Pride Construction and Development,Inc
State of Massachusetts,License Number Copy attachod.or
to be delivered no later than 7 business days of contract execution
ARTICLE 2
DATE OF COMMENCEMENT AND ESTIMATED COMPLETION DATE
1. The date of commencement Shall be the date of this executed Agreement, unless otherwise indicated
below. The Contractor shall substantially complete the Work with all due diligence and not later than
Thirty (30) days from execution unless mutually agreeable and subject to, if any, adjustment by Change
Order,
2.Contractor is not responsible for delays due to changes by governing official's, owners,
or Inclement weather-
ARTICLE 3
CONTRACTSUM
1.Subject to additions and deductions by Change Order,the Contract Sum is:
Sixty Eight Thousand Four Hundred Eighty Eight Dollars and 25/100 (56&AB&25)as described for
work outlined in:Exhibit A&AA
2.For purposes of payment,the Contract Sum includes the following values related to portions of the
Work:Per attached:Exhibit"A&AX1 -`Scope of Work'(dated December 16,2010)
3.The Contract Sum shall include all items and services necessary for the proper execution and completion
of the Work.
As Specified in Exhibit"A&A.1"'Scope of Work'
AR CL 4
PAYMENT
1. Based on Contractor's Applications for Payment submitted to the Owner, the period covered by
each Application for Payment shall be seven(7)calendar days ending on the last day of the week,
or as follows: