29 HANSON ST APT 2 - BPA The Commonwealth of Massachusetts T -dl
Board of Building Regulations and StandardsEq
Board
ALEMassachusetts State Building Code,780 CMR ar 011
:Building Permit Application To Construct Repair,Renovate
p One-or Two Family Dwelling
Building Potadt,Number Date Applied
s
t
_ - 13�uldingOi�ciatl e) 1 :: Signature
,• BECTI(�V 1:SITS II+TPOttiklAT[DN -
' 1.1 Pro rty Addr s: 12 Assessors Map&Parcel Numbers
R N�� sAz
�-` l.la Is this an accepted street9 yes_ no Map Number Parcel Number
13 Zoning Information: 1.4 Property Dimensions:
Zoning District Proposed Use Lot Area(sq ft) Frontage($)
1.5 Building Setbacks(ft)
Front Yard Side Yards Rear Yard
Required Provided Requued 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 disposal system ❑
Public 13 Private E3 Check if yes❑
SECTION 2: PROPERTY'OWNERSt
2.1�QSrp(�R�cord: CMGs--
\\ �J w15
Name(Pr�(�'tt) \\ nn '' nn City,State,ZIP
2� � C"vsoN est �t�� CI?FS3b429o5 Ve+ b ;3
No.and Street Telephone EMMAddreSS
SECTION 3:DESCRIPTION OF PROPOSED WORKS(ebeck all that apply)
New Construction Cl Existing Building❑ Owner-Occupied ❑ Repairs(s) ❑ Alteration(s) ❑ Addition ❑
Demolition ❑ 1 Accessory Bldg.❑ Number of Units_ Other ❑ Specify:
Brief Description of Proposed Worlrz: I l ) R L t-
r\ � n car OF C.N tMn1�l�1 tVnN 11n lad? Y�-,84srnt[-r
SECTION 4:FSTIlk1ATED CONSTRUCTION COSTS
Estimated Costs: Official Use Only
Item abor and Materials .w .. .
1.Building $ 2200
I. Buikting Permit Pca $ Indicate how fee is determined-
1. Standard Cityfrown Application Fee
2.Electrical $ O Total Project Cost'(Item 6)x multiplier x
3.Plumbing $ ti Oa 1 Other Fees:
4.Mechanical (HVAC) $ '
5.Mechanical (Fire $ Fota1 AIl Fees:$
Suppression)
Check Nib. Cheek Amount: Cash Amount;
6.Total Project Cost: $ 2 g �� 13 Paid in Pull ❑Outstanding Balance Due:
�i
SECT[ NI - COMTRWirIONSSRVIM
5.1 Construction Supervisor License(CSL)
License NumberExpiration Date
NameofCSLHolder`"
List CSL Type(see below)
No.and Street Dea�xtphon '
Unrestricted to 35,000 cu.ft.
IWRC
Restricted Family Dwelling
City/Town,State,ZIP Masonry
RoofingCoverin
Window and Siding
Solid Fuel Burning Appliances
Insulation
Tel hone Emailaddress I Demolition
5.2 Registered Home Improvement Contractor(HIC)
HIC Registration Number Expiration Date
HIC Company Name or HIC Registrant Name
No.and Street Email address
Ci /town State ZIP Tel hone
S)£GTIOTI&WORKERS'C MPEPISA'ITON 1ZCaMANCE.AFN'IDAVIT(ALGJt c.152.§25G(�)
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 Attacbed? Yes ..........❑ No...........❑
SECTtbN 7at OWNER AMOIUZA ON TO BE CO LETED WHEN
WNER'S ACZNT OR Q' TqR AFPLMS FOR AMPM MUM
1,as Owner of the subject property,hereby authorize
toact on my behalf,in all matters
\relative to work authorized by this building permit application. `
Print waer's Nle(Electronic Siature) Date
SECTION 76t OWNER!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.
Print Owner's or Authorized Agent's Name(Electronic Signature) Date
NOTESa
1. An Owner who obtains a building permit to do his/her own work,or an owner who hives 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
wtivw.mass. og v(oca Information on the Construction Supervisor License can be found at M3M.mass.gov/dps
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 beating system Number of decks/porches
Type of cooling system Enclosed Open
3. "Total Project Square Footage"may be substituted for"Total Project Cost"