16 BECKFORD ST - BPA-2009-878 DECK � 1
40ne-
onwealth of Massachuscits
,—, ing Regulations and Standards Town of
Oman
MassBuilding Code, 780 CMR, 7ih edition Building
Building Permo Construct, Repair, Renovate Or Demolish a !tmoftwhma
r Tno-Famill Duelling ANN&
C� This Section For OficialUse Only
Building Permit tuber: Date Applied:
Signature: "" / 1013
Building Commissioner/I Spector of Buildings Date
SECTION 1: SITE INFORMATION
1.1 Property Address: 1.2 Assessors Map& Parcel Numbers
1.la Is this an accepted street?yes_ no Map Number Parcel Number
1.3 Z ping Information: p 1.4 Property Dimensions:
�,z sti�(e
Zoning District Proposed Use tf3+t i ° Lot Area(sq A) Frontage(R)
1.5 Building Setbacks(B) -
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 esO
SECTION 2: PROPERTY OWNERSHIP'
2.1 Owner'of Record: St;
Name(Prir L � Address for Service:
( ��� 0 z7
Signature Telephone
SECTION 3:DESCRIPTION OF PROPOSED WORK'(check all that apply)
New Construction❑ Existing Building❑ Owner-Occupied Repairs(s) Alteration(s) ❑ Addition ❑
Demolition ❑ Accessory Bldg. ❑ Number of Units_ Other 13 Specify:
Brief Description of Proposed Work':
/2f prLr Y/ net,L' � iwy n �- 1W er - —
r
SECTION 4: ESTIMATED CONSTRUCTION COSTS
Item Estimated Costs: Official Use Only
Labor and Materials
I. Building $ ,y,�Q 1. Building Permit Fee: S Indicate how fee is determined:
2. Electrical S ❑Standard City/Town Application Fee
O Total Project Cost (Item 6)x multiplier x
J. Plumbing S 2. Other Fees: $
4. Mechanical (HVAC) S List:
5. Mechanical (Fire S Total All Fees: S
Suppression)
Check No. _Check Amount: Cash Amount:_
u"0'�1 ❑ Paid in Full O Outstanding Balance Due:
6. Total Project Cott: S5
-! V
/ r
SECTION 5: CONSTRUCTION SERVICES
5.1 Licensed Construction Supervisor(CSL)
'• CS' 2-2-6?5 License Number Expiration Date
N,�roc u(CSL- HQhJrr ^ �f /� y List CSL Type(see below)
a /S 2Ute /'t lSC4G�fhJ 11
Address /� 1Z T Description
/_ / Pt/�,'.Q ` f• ,Jzu�/y U Unrestricted u to 35,000 Cu. Ft.)
(9 J 1 / R Restricted 1&2 Family Dwelling
Signature �i9 .M Masonry Only
qy8 12738 l RC Residential ooling Covering
Telephone WS Residential Window and Siding
SF Residential Solid Fuel Burning Appliance Installation
D Residential Demolition
5.2 Registered Home Improvement Contractor(HIC) 7D 07�0�
HIC Company Name or HIC R%istrant Name Registration Number
�s
Address
?B y 2J3zV Expiration Dam
Signature Telephone
SECTION 6:WORKERS'COMPENSATION INSURANCE AFFIDAVIT(M.G.L.c. 152.9 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...........O
SECTION 7a:OWNER AUTHORIZATION TO BE COMPLETED WHEN
OWNER'S AGENT OR CONTRACTOR APPLIES FOR BUILDING PERMIT
1, as Owner of the subject property hereby
authorize ¢.ucG /Lj �-I` W��LL to act on my behalf,in all matters
relative to work authorized by this building permit application.
Signature of Owner Date
SECTION 7b:OWNER'
OR AUTHORIZED AGENT DECLARATION
1 yc,G 14- ,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.
A2 we L
Print NMF
Signature Winer or Authorized Agent Date
"Sined under the pains and penalties ofperjury)
NOTES:
[I.:An Owner who obtains a building permit to do his/her own work,or an owner who hires an unregistered contractor
ot registered in the Home Improvement Contractor(HIC)Program),will W have access to the arbitration
ogram or guaranty fund under M.G.L. c. 142A. Other important information on the HIC Program and
nstruction Supervisor Licensing(CSL)can be found in 780 CMR Regulations 110.116 and 110.115, respectively.
When substantial work is planned,provide the information below:
otal floors area(Sq. FL) (including garage, finished basement/attics,decks or porch)
ross 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'