5 ABERDEEN ST - BPA-15-405 RESHINGLE, WINDOW f O The Cummonwealih of Massachusetts
Town of
Board of Building Regulations and Standards �~
a� Massachusetts State Building Code. 780 CMR. 7'"edition Budding Dept
Building Permit Application To Construct. Repair- Renovate Or Demolish a
doom
One- or Twsu-Funuh Duelling
Thi Section For 0 1 aal'Use Only
Building Permit Number, ate Applied: '
7-
Signature: Il 2 6�
Building C issi r/In uldmgt Due
SECTION 1:SITE INFORMATION
1.1 Property Address: 1.2 Assessor$Map dt Parcel Numbers
F" �b.E�'C�o D ! 5•k.po } - Parcel Number
I.la Is this an arc ted street:'yes Map'p Number
IJ Zoning Information: 1.4 Property Dimensions:
Zoning District Proposed Use La Area(sq R) Frontage(R)
13 Building Setbacks(it)
Front Yard Side Yards Rem Yard
Required Provided Required I Provided Required Provided '
1.6 Water Supply:(M.G.L c.40,154) 1.7 Flood Zone Information: 1.11 Sewoge Disposal System:
/ Zone: _ Outside Flood Zone? Municipal O On site disposal system O
Public o- Privan O Check if ves,
SECTION 2: PROPERTYOWNERSNIP'
2.1 Owoar'of Record:
Name(Print) A for service:
Signature Telephone
SECTION 2: DESCRIPTION OF PROPOSED WORK'(cheek as that apply)
New Constnulion O Fainting Building O Owner-Occupied G Repain(s) O Altereticn(s) Addition O
Demolition O f Accessory Bids.O Number of Uniu_ Other O Speeiy:
Brief Description of Proposed Work': �T�i P cp .Sh�t� I i n 5 -�L rl�ro✓ Lain�(eui�
Lv)�F ✓
SECTION a: ESTIMATED CONSTRUCTION COSTS
Estimated Costs: OAlclal Use Only
Item Labor and Materials
I. Building f � I. Building Permit Fee: f Indicate how fee is determined:
Standard Ciry/Town Application Fee
2 Electrical f O Total Project Cost'(Item 6)a multiplier ■
) Plumbing S 2. Other Fees: f
a Mechanical (HVAC) S List:
s Su Nechression
iion) (Fire S Total All Fees. f
Check No. _Check Amount: Cash Amount:
is Total Project Cost f 'L t7�U 0 Paid in Full 0 Outstanding Balance Due
Air
SECTIONS: CONSTRUCTION SERVICES u S.I Licensed Construction Supervisor(CSL) e5 b?Z
b C� Z—k l�7 Lweme Numb r Empndnon Dim
.Nyat YI'CSL- If IJer Lw C SL Type(sev he low)
Address Description
77
ds-�: ���� zj U re"sulcled u to N,000 Cw Ft
Restricted 162 Family D%ellinst
S16n;1 /e N Masonry Only
RC Residential Ronlin Covering
Telephone wS Residential Window and Siding
SF I Residential Solid Fuel Burning Appliance Installation
D I Residential Demolition
5.2 Rer:Tme Improvement Contractor(HIC)
HIC Company Name or HIC R6 straw Name Registration Number
agp
pirstion Date
Signature Telephone
SECTION 6:WORKERS'COMPENSATION INSURANCE AFFIDAVIT(M.G.L.e. ISL§ M(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 Issuanc the building permit.
Sighed AffidavitAmached7 Yn.......... er No........... 13
SECTION 7a:OWNER AUTHORIZATION TO BE COMPLETED WHEN
OWNER'S AGENT OR CONTRACTOR APPLIES FOR BUILDING PERMIT
1, as Owner of the subject property hereby
authorize to act on my behalf,in all matters
relative to work authorized by this building permit application.
Si azure of Owner Date
SECTION 7b:OWNER'OR AUTHORIZED AGENT DECLARATION
1. , as Owner or Authorized Agent hereby declare
that the statements and information on the foregoing application are true and accurate, to the best of my knowledge and
behalf.
� � l
Print Name /
Signature of-Owner or Authorized Agent Date
Si ned under the pains and penalties ofperjury)
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 fm have access to the arbitration
program or guaranty fund under M.G.L. c. 102A. Other important information on the HIC Program and
Construction Supervisor Licensing(CSU can be found in 790 CMR Regulations 110.R6 and 110 RS, respectively.
2. When substantial work is planned,provide the Information below:
Total floors area(Sq. Ft.) (including garage, finished basement/anics,decks or porch)
Gross living area(Sq. FL) Habitable room count
Number of fireplaces V umber of bedrooms
Number of bathrooms Number of half baths
Type of heating system Number of decks/ porches
Tvpe of cooling system Enclo.ed . Open
1 "Total Project Skluare Footage"may he.uhsiauicd for"Total Project Cost"