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38 BUCHANAN RD - BPA-16-940 j :f) !oq S 14 '• .. _ Ml The Commonwealth of Massachusetts 's w$ 1 Board of Building Regulations and Standards CI��TIIYOIF Massachusetts State Building Code,780 CMR 26Ib AUG 2 3 Risdr7A Zoll © Building Permit Application To Construct,Repair,Renovate Or Demolish a One-or Two-Family Dwelling Q� `.." ;: ,. This Seeflon Fur OfRoial Use Oat , . t Building Peiaik,Namber Date . pood: t 1 gOfcial(rrint e) she (� SEMON IS SM MOORi►II:a.TION 1.1 PrypertyAddress: 1.2 Assessors Map&Parcel Numbers `'� 36 Y3tsc.ha nay. Lla Is this an accepted street?yes V no Map Number Parcel Number 13 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 Ward 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: Zone: _ Outside Flood Zone? Municipal❑ On site al stem ❑ Public❑ Private❑ Cbeck if es❑ disposal sy SECTION 2: PROPERTYOWNERSI1BPt 2.1 OwnerrofRecord: ._ STeO� `TSE Name(Print) City,State,ZIP 360 q7LjyY- No.and Street Telephone Email Address SECTION 3:DESCRIPTION OF PROPOSED WORKS(cheek all that apply) New Construction❑ Existing Building❑ Owner-Occupied Repairs(s) ❑ 1 Alteration(s) ❑ Addition ❑ Demolition ❑ Accessory Bldg.❑ Number of Units_ Other ❑ Specify: Brief Description ofi Proposed Worlr`: ym< K o ' 2 0o r L 1, min Y31�l-1 Rvovn 'Lhs i ASU— S�u��P SECTION 4:ES CONSTRUCTION COSTS Item Estimated Costs: 015cial Use Only (Labor and Materials _ - I.Building $ '36.96 5 i [$ 1., Building Permit Feei$ Iitdloate how fee is determined O u o0 Standard City/Town Application Fee 2.Electrical $ �/ O Total Project Cost'(Item 0 x multiplier x 3.Plumbing $ UUP i 2. Other Fees: $ 4.Mechanical (HVAC) $ List 5.Mechanical (Five $ Total All Fees:$ Suppression) 3 9 3 ,'� ��No. Cheek Amount: Cash Amount:- 6.Total Project Cost: $ ❑Paid in Full ❑Outstanding Balance Due: SEC IMM 5: C0f0TRVCTr0N SERVICES 5.1 Construction Supervisor License(CSL) C5 -0066[j ti /fro l 1C� 1 R rnlA3 . ,i ��4,P� License Number7 inti Date Name of CSL Holder List CSL Type(see below) 2L RH R n I L No.and Street mie4noa S G,)+kwt ps(O I T 1 1 rf7 U Restricted l&2 Family Dw gs up to 35000 w.ft. ?Sty/Town,State,ZIP— M Masonry U l R O /-t RC goofingCovering WS window and Si 70-7 2 a I Insulation Burning Appliances 7 0 / Telephone Email address D Demolition 5.2 Registered Rome Improvement Contractor(RIC) Lie M F1S E ��AY E S Con 570-vC-rN N HIC Registration Number Expiration Date HIC Compaoy,�Iame or HI�RCg strant Name '1,( t C.l�,t� No.and S4M S C Email address Ci /town State ZIP G Q O Tel one SECTION 61 WOREERS'' MATION DMIRANCE AFFIDAVIT(NLG.- c.152.4 25CM) 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...........❑ ACTION7a,OWMR AVTIFORIZA TO FIE Co?"Un"WIMN WNEIi'S PTI 4R 9 TOR FQ INQ P I" I,as Owner of the subject property,hereby authorize 1 1.,P6 'f e 5 to act on my behalf,in all matters relative to work authorized by this building permit a plication. 'J'&; n ,rja. 8/23(/6 Print Owner's Name(Electronic Signature) Date e SECTION'M OWIN&W OR AUTHORIZED AGENT DECLARATION By entering my name below,I hereby attest under the pains and penalties of perjury that all of the information contained in this application is true and accurate to the best of my knowledge and understanding. Th o1MHS E i-��yr:S a 3 116 Print Owner's or Authorized Agent's Name(Electronic Signature) Date 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 a»vw.mass.gov.'oca Information on the Construction Supervisor License can be found at wA-wmass.gov/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"