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B-17-1166 - 0008 BARR STREET - Building Permit The Commonwealth of Massachusetts Board of Building Regulations and Standards FOR Massachusetts State Building Code,780 CMR MUNICIPALITY USE Building Permit Application To Construct,Repair,Renovate Or Demolish a Revised Mar 2011 One-or Two-Family Dwelling This Section For Official Use Only (t Building Permrt Number Date A lied: ` Building Official(Punt Name) Signature SECTION 1:SITE INFORMATION 1.1 Property Address: 1.2 Assessors Map&Parcel Numbers CY ftRR Sr L l a Is this an accepted street?yes no Map Number Parcel Number [1.5 3 Zoning Information: 1.4 Property Dimensions: oning District Proposed Use Lot Area(sq ft) Frontage(ft) 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? Check if yes❑ Municipal❑ On site disposal system ❑ SECTION 2c PROPERTY OWNERSHIP' 2.1 Owner'of Record: Name(Print) City,State,ZIP MAR s T 7,9 No.and Street Telephone Email Address SECTION 3:DESCRIPTION OF PROPOSED WORKZ(check all that apply). New Construction❑ Existing Building Owner-Occupied Repairs(s) ❑ 1 Alteration(s) ❑ 1 Addition-❑ Demolition ❑ Accessory Bldg.❑ Number of Units_ Other Specify:WJ,4r6VA IZ41/04/ Brief Description of Proposed Work 2: -TAUULA-r< ,,47T/C *kXTU/nR WALLS WITH loBLeWA) C—awt�oS SECTION 4:ESTIMATED CONSTRUCTION COSTS Item Estimated Costs: Official Use Only Labor and Materials Y 1.Building $ 00 1. Building Permit Fee:$ Indicate how fee is determined: 2.Electrical $ ❑Standard City/Town Application Fee ❑Total Project Costa(Item 6)x multiplier x 3.Plumbing $ 2. Other Fees: $ 4.Mechanical (HVAC) $ List: 5.Mechanical (Fire Suppression) $ Total All Fees:$ Check No. Check Amount: Cash Amount: 6.Total Project Cost: $ - 60 ❑Paid in Full ❑Outstanding Balance Due: s I Z SECTION 5 CONSTRUCTION SERVICES 5.1 Construction Supervisor License(CSL) Sal®B 7,-f AD DA1116Ff C License Number xpiration Date Name of CSL Holder sw�AC� Q List CSL Type(see below) /®IH Z5, ffiA L� Type Description No.and Street U Unrestricted uildin s u to 35,000 cu.ft. a Flf-�b ��. ©/ ! R Restricted 1&2 Family Dwelling City/Town,State,Z M Masonry 1 RC Roofing Covering WS Window and Siding SF Solid Fuel Burning Appliances 61 I Insulation Tel hone Email address D Demolition 5.2 Registered Home Improvement Contractor(HIC) 1/61 S� 5� 0- r ST/ !0AJ7-kfCT A[ 0 co . HIC Registration Number Expiration Date HIC Company Name or HIC Registrant Name JU_EtALHIMO-OW sf No.and Street �/� Email address A11}L i//D&/ , O f l/j�. CJLZ 1 r�)Il City/town,State,ZIP Telephone SECTION 6:WORKERS'COMPENSATION INSURANCE AFFIDAVIT(M.G.L.c.152:§ 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 ..........IDS No...........❑ SECTION 7a:OWNER AUTHORIZATION TO BE COMPLETED WHEN OWNER'S AGENT:OR CONTRACTOR APPLIES FOR BUILDING PERMIT I 1,as Owner of the.subject property,hereby authorize_ S'�/CLA C62/`IAC"T % to act on my behalf,in all matters relative to work authorized by this building permit application. Print Owner's a(Electronic Signature) Date SECTION 7b:OWNEW 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 wner's or Authorized Agent's Name(Electronic Signature) Date NOTES: 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 www.mass.gov/oca Information on the Construction Supervisor License can be found at www.mass.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"maybe substituted for"Total Project Cost" ' l