6 ABERDEEN ST - BPA-08-858 RESHINGLE, WINDOW The ComirowNealth of Massachusetts
Board of Building Regulations and Standards fOR
MllNl
Massachusetts State Building Code. 780 CMR, T°edition [I F�LI'11'
Building Permit Application To Construct, Repair, Renovate Or Demolish a Ret i,ved Junuw,c
One- or Tiro-Fmnily Dwelling /. 008
This Section For Official Use Only
` Building Permit N '6er: Date Applied:
Signature:
Building Commissioner/Inspectorof Buildings Date
SECTION 1: SITE INFORMATION
1.1 Property Address: 1.2 Assessors Map & Parcel Numbers
1.1a Is this an accepted street?yes no_ Map Number Parcel Number
1.3 Zoning Information: 1.4 Property Dimensions:
Zoning District Proposed Use Lot Area(sq It) Frontage if)
1.5 Building Setbacks(ft)
Front Yard Side Yards Rear Yard
Required Provided Required Provided Require) Provided
1.6 Wate pply: (M.G.L c.40. §54) 1.7 Flood Zone Information: 1.8 Sewage D�fsposal System:
Zone: _ Outside Flood Zone? Municipal On sne disposal system ❑
Public Private❑ Check if es❑ p y
SECTION 2: PROPERTY OWNERSHIP'
2.1 Owner o[Record:
PAVL KEN (y 1gVz rz,-),6, jr
Name(Print) Address for Service:
q76- ) 7 3 7 3
Signature Telephone
SECTION 3: DESCRIPTION OF PROPOSED WORK2(check all that apply)
New Construction❑ Existing Building ❑ Owner-Occupied ❑ 1 Repairs(s) 19K I Alteration(s) ❑ Addition ❑
Demolition ❑ 1 Accessory Bldg. ❑ Number of Units_ I Other O Specify:
Brief Description of Proposed Work': Xo- 12it1 /Lo6r 4-6
(),JR-t.
SECTION 4: ESTIMATED CONSTRUCTION COSTS
Item Estimated Costs: Ofticial Use Only r
(Labor and Materials) cIQ
I. Building $ 3D�, p. I. Building Permit Fee: $ Indicate how fee is determined:
�) ❑Standard City/Town Application Fee
2. Electrical $
❑Total Project Cost (Item 6) x multiplier x
�\rl 3. Plumbing $ 2. Other Fees: $
�`� J 4. Mechanical (HVAC) $ List:
w 5. Mechanical (Fire $ Total All Fees: $
sup ression)
Check No. Check Amount: Cash Amount-.
6. Total Project Cost: $ ❑ Paid to Full ❑ Outstanding Balance Due:
SECTIONS: CONSTRUCTION SERVICES
5.1 Licensed Construction Supervisor(CSL) E z p D 3 Z A 7
o`#{ - License Number Expiration Dale
Namc of CSL- Huldrr Cff �Jl List CSL Type(sea hlow) -
�07 /�R�f+�T r LA! Kd nJ-rf �Jc3C
ddn. T Description
>
ddre U I Unrestncied top to 33.000 Cu. Ft.)
R I Restricted 1&2 Family Dwellin
Sign, re r- M I Masonry Only
97? -eC4 RC I Residential Roofing Covering
Telephone WS Residential Window and Sidin
SF Residemial Solid Fuel Burning %pillialicc hl,tallation
D Residennal Demolition
5.2 Registered Home Improvement Contractor(HIC)
HIC Company Name or HIC Registrant Na Registration Number
Nam
Address
r Expiration Date
Signator; Telephone
SECTION 6: WORKERS' COMPENSATION INSURANCE AFFIDAVIT(M.G.L. c. 152.$ 2506))
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 ........... ❑
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.
Signature of Owner Date
SECTION 7b: OWNEW OR AUTHORIZED AGENT DECLARATION
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.
Print Name
Signature of Owner or Authorized Agent Date
(Signed under the pains and penalties of perjury)
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 not have access to the arbitration
program or guaranty fund under M.G.L.c. 142A. Other important information on the HIC Program and
Construction Supervisor Licensing(CSL)can be found in 780 CMR Regulations 1 10.R6 and 110.115, respectively.
2. When substantial work is planned.provide the information below:
Total floors area(Sq. Ft.) (including garage, finished basementlattics.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"