29 BUCHANAN RD - B-16-901 iHo CK- zi [c)
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The Commonwealth of Massachusetts �eC)1� i I IITY OF
'!N ! Board of Building Regulations and Standards
E Massachusetts State Building Code, 780 C � JUL �� j� $SALEM
'i sed Mar 2011
Building Pennit Application To Construct, Repair, Renovate Or Demolish d
One-or Two-Family Divelling
This Section For Official Use Only
( Building Permit Number: _ Date Applied:
Building Official(Print Name) .Signature Date
SECTION t: SITE INFORMATION
1.1 Pro erty dreg�: 1.2 Assessors Map& 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 Arca(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 ves❑
SECTION 2: PROPERTY OWNERSHIP'
2.1 O r�of Record: 1 6-
-0-r-e5eL le,nit t
Name(Print) ,? Ciry,State,ZIP
/ ' Glcrltxl� awl+d'/_C>+_Qg �e:SSfl. ~?�et�.Yrzo a.v. rrrvl
No.and Street Telephone Email A dress
SECTION 3: DESCRIPTION OF PROPOSED WORK' (check all that apply)
New Construction ❑ 1 Existing Buildin Y _ Owner-Occupied ❑ Repairs(s) ❑ Alteration(s) ❑ Addition ❑
Demolition ❑ Accessory Bldg. ❑ Number of Units Other ❑ Speci(y:
Brief Des•ription of Proposed Wark`: ({4-flirt s - �Y Z_t .4. 3
�Sf r e of ea-i
t
SECTION 4: F,STTMATFI)CONSTRUCTION COSTS
Estimated Costs:
hem Official Use Only
(Labor and Materials)
I. Huildin1 $ cif ��7r Jo 1.. Building Permit Fee: $ Indicate how fee is determined:
2. Electrical $ ,41 -. ❑Standard City/Town Application Fee
> ❑ Total Project Cost'(Item 6)x multiplier x
3. Plumbing ---..._ __$__/4,! V , 0 0' 2. Other Fees: S
4. Mechanical (HVAC) S "(�" List: _
S. Mechanical (Fire
Suppression) $ �i��/1" Total All Fees: $
J Check No. Check.Amount: Cash Amount: `
0.Total Project Cost: $ !�r /f,-, °� ❑Paid in Full - ❑ Outstanding Balance Due:
�t.�,0dv-rS V�ZCC�AI�
SECTION 5: CONSTRUCTION SERVICES
5.1 Cpustruction Su ep rejsor License(961-) N/ •-v 4
License N— umber E.xpvation ate
-_—_ ....
an,e of CSL Holc el
L
G�/ ST .List CSL Type(see below)
No.and Street n �1�j// Type Description
City f",ea S (iL /V G/7/1 VJV`Q� U __ Unicsnrcted(Buildrn,s a to 33.000 cu, ft.)
late,l.IP
--- R Restricted 1&2 Family Dwelling
M Masomv
RC Roofing Covering
f �� �- ��La� 6V5 Window and Siding
�Q3 r SF Solid Fuel Burning Applimnces
SGS U-Ap,-C � I Insulation
Telc,hone Email ress i D Demolition
5.2 Registered Horne Improvement Contractor
(HIC)
�J �01C i��- /1-0- �''�✓I�--fig t- I .istrtartzionn Number E piral-
H Com any Name or Re�.+3tryv game
lily
dAhr,2 s '�—___ w� SroreconSh-uCA?JJ C �c✓n
N end Street
0 2-- It o ---c 3 7 J En,ai1 address
City/Town,State,ZIP f Telephone
SECTION 6: WORKERS' COMPENSATION. INSURANCE AFFIDAVIT(M.G.L. c. 152. § 25C(6))
Workers Compensation Insurance affidavit must be completed and submitted with thisapplication. Failure to provide
this affidavit will result in the denial of fire Issuance of the building permit.
Signed Affidavit Attached? Yes .......... No...........
SECTION 7a: OWNER AUTHORIZATION TO BE COMPLETED WHEN
OWNER'S AGENT OR CONTRACTOR APPLIES FOR BUILDING PERMIT
I,as Owner of the subject property,hereby authorize Q& �-L-
to act on my alf, in till matters relative to work authorized by this building permit application.
Print Owner's Name(Electronic Signature) ate
SECTION 7b: OWNEW OR AUTHORIZED AGENT DECLARATION
By entering my name below, 1 hereby attest under the pains and penalties of periury that all of the inforaation
contained 1114his app (SL lica jt tr e and accurate to the best of nmy knowlcdse and wmilerstanding-
I � �Gery 6/29/16
II' —
Priiv Owner's or Authorised Agent`s Name(Electronic Signature) � Cate
NOTES:
I. An Owner who obtains a building permit to do his/hcr own work,of an owner who hires an unregistered contractor
(not registered in the Home Improvement Contractor(NIC)Program), will not have access to the arbitration
program or guaranty fund tinder NI.G.L c. 142A. Otherimportant information on the FITC program can be found at�
www mass ov/oca Information on the Construction Super visor License can be found at www nnass.gov/dam
When substantial work is planned,provide the information below:
Total Floor area(sq. ft.) (including garage,finished basenmendattics,decks or porch) 1
I Gross living area(sq. ti.)__ __ Habitable room count !
Number of fireplaces_______— Number of bedrooms
1 Number of bathrooms_ _ Number of half/bath _
1 'Type of heating system Number of decks/poi cher
Type of cooling system_ .Enclosed Open
3. "Total Project Square Footage"may be substinncd for "Total Project Cosi'
e
t
Massachusetts Department of Public Safety
Board of Building Regulations and Standards
Licgnse: CS-109174 . .
Construction Supervisor
1 T
� STEVEN REYNOLDS
73 LOCKSTREET 1
NASHUANH 03064„
^' Expiration:
Commissioner 03126/2019
.............
Office of Consumer Affairs&Business Regulation
i HOME IMPROVEMENT CONTRACTOR
in Registration: 183264 Type_
.wrn
OF"'; Expiration: 9/22/2017 LLC
SCORE CONSTRUCTION SERVICES LLC. -
PAUL OUELLETTE
3 SAN DBORN RD
LONDONERY,NH 03053 Underserreta arry
License or registration valid for individul use only
before the expiration date. If found return to:
.Office of Consumer Affairs and Business Regulation
All Park Plaza-Suite 5170
Roston,MA 02116
Not,alit without signature
EXISTING COLLAR
COLLAR
TIE 2X10 NEEDS
TO BEV I.F BY
CONTRACTOR - '" "'' -- --
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6.29.2016
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