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B-17-596 - 0004 ANDOVER STREET - Building Permitf n ryr „• s� The Commonwealth of Massachuse, ��4� ,. ,•�,i rfiu�• LJ Board of Building Regulations and,S� I *" `" `f'4��'" CITY OF Massachusetts State Building Code,780 CMR LE Revised AA—2011 Building Permit Application To Construct,Repair, O& erholis`fl a e r i T One-or Two-Family Dwelling Thts SecCton FQr., STictai.U$e �' Bdmg 1'ena»t Number.. Date 1pplaed . f }: Bwldupg Ol�c�al(Prhnt Name) Stg©aAse - Date CQ}V;1'SITT IN (IMA1'ION 1.1 Pr a Address: 1.2 Assessors Map&Parcel Numbers I.IL Is,this an accepted street?yes no Map Number Parcel Number 1.3 Zoning Information: 1.4 Property Dimensions: . E 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 c.40,§54) 1.7 Flood Zone Information: "1.8 Sewage.Disposal System: Public El Private❑ Zone: _ Outside Flood Zone? Municipal❑ On site disposal system ❑ Check if yes❑ SECTION 2: PROF.RTY.OWNEltSHIT'1. 2.141 Record:1 .H d UYr , N�— City,State,ZIP No.and Street Telephone Email Address - SECTION 3-DESCRIPTION OF PROPOSED WORK2(etieek all that'app New Construction❑ Existing Building❑ Owner-Occupied ❑ Repairs(s) ❑ 1 Alteration(s) Addition ❑ Demolition ❑ 1 Accessory Bldg.❑ Number of Units Other ❑ Specify: B 'ef Description of Proposed ork2: Lo- W u SECTION 4-:ESTIMATED.CONSTRUCTION COSTS . Item Estimated Costs: O eal Ilse Onl (Labor and Materials . 1.Building $ bf� 1. Bttr`ldng Permit Fee.$` Indicate how11ke is.determined. 2.Electrical $ ) w O Standard CityPtown A. leatisnFee q Total Proleat Costs(Itetit f)x_ ulhpher x. 3.Plumbing $ a, W 2: Ocher Fees. 4.Mechanical (HVAC) $ List 5.Mechanical (Fire $ Suppression) 'Total All Fees:$ Cheek No. Check Amount: Cash Amount: 6.Total Project Cost: �Z go-0-D ❑Paid in Fall b Outstandin' Balance Due: i SECTION 5: CONSTRUCTION SERVICES 5. Constru tion Supervisor License(CSL) Tpai License Number n Date N.une of C L FFo1Je l \ list CSL'fype(see below) _ 1JP 1� 1 " TY ,. Description ._ No.and Street U UnreslricteJ(Buildings no to 35,000 cu. It. Ah on R Restricted I&2 Family Dwelling City/town,Sta ,ZIP All 114sonry RC Rootnig Coverinst WS Window and Sidinit SF Solid Fuel Burning Appliances �� off- a�G I Insulation . Telephone Email address D Demolition 5.4 JReghV4q0Home Im rovement Contractor(HIC); 11 4�;�tv �� H C Regis tion Number Expiration Date II any N qr FI(C Reg' trant Name a� and S t J Email address Ci /town State ZIP Telephone SECTION 6:WORK E '.COMPENSATION INSURANCE AFFIDAVIT(M:G:G:.c.192'.§25C(6)}_. Workers Compensation Insurance affitlavvit must be completed and submitted with this application. Failure to provide this affidavit will result in the denial of tLN4uance of the building permit. ' Signed Affidavit Attached? Yes No...........O SECTION Tar OWNER AUTHORIZATION�TO BE.COMPLETED.WHEN' OWNER'S AGENT OR CONTRA ORAPPLIES.F�OR'8UILDING:PERMIT` I,as Owner of the subject property,hereby authorize W, - t9 ac on m ehalf,in all atters relative to work authorized by this building permit application. �1 Print wner's Name(ElectrtMic ignature) pate SECTION 7b:OWNEW ORAUTHORIZED AGENT DECLARATION By entering my name below,I hereby attest under the pains and penalties of perjury that all of the information con red in t ' lication is true and accurate to the'best of my knowledge and understaridin . Print Owner's or Auhhorizc Agent's Name(Electronic Signature) act NOTES: I. 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#rot have access to the arbitration program or guaranty fund under 1I.G.L.c. 142A.Other important information on the HIC Program can be found at %vw%v.mass.cov/oca Information on the Construction Supervisor License can be found at 4yww.niass.aw/d0 . i 2. When substantial work is planncd,provide the information below: 'focal floor area(sq.R.) N (including garage,finished basementlattics,decks or porch) Gross living area(sq.tl.) 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" " P I �i ij j f � ' l F � - .� s N i r i i t _ r t 9 9 i g _: 77 - --4 Iv s , \ � --- - - -- --d s. . - �,. � I r v f . � �- ! "�,---_. ' i -- . .. i � ! + 1 i , / t �_ ; ..�__._ p ,_ �_ 0-- hh f i � t 4 ''.. L� ' �i Y -_-._.____ 4 i j i i � _ � � , i � � � i i � I ��'+ A� I� ii �� C� r-. ' .w __ 4 _ __ _ _.._ _ y . __ - . . _ _ � , . -----_ ,, r �i � � �i 'i f _ - - � �. - G } i _,.. � h � i i 1� i t� � � � � _ , 1 _ � � - �� . j - � � � -�. �, y 6 � , � , ! ` I . G� � �- d f 1 � II t f � t T I f + o � s _ w r w_ ' I aL S (� 5 a n � V J � y '• V } i { X C p � ! i Q k b y i ' S i i 1 G Q s• _ M1 5 FD� 7:5 r \� V G