23 ABORN ST - BPA-10-291 BRING 4 UNITS UP TO CODE i
The Commonwealth of Massachusetts
Board of Building Regulations and Standards Town of
B
�
Massachusetts State Building Code. 780 C ng oe. MR, Ts edition Building Dept
Building Permit Application To Construct, Repair. Renovate Or Demolish a *tmommduft
�I l One-or Tito-Funirh Duelling
This Section For Official Use Only
Building Permit Nu c Date Applied: ir0
Signature:
Bud - SCammissioner I s t YBuildings Due
SECTION 1:SITE INFORMATION
1.1 �.grty Add i s- s Q 1.2 As Map& Parcel Numbers
1.Is is this an accepted street?yes ✓ no Map Number Parcel Number
1.3 Zoning Information: 1.4 Property Dimensions:
Zoning District Proposed Use La—AN a(sq R) Frontage(R)
1.3 Building Setbacks(R)
Front Yard Side Yards Rear Yard
Required Provided Required Provided Required Provided
-
1.6 Water Supply:(M.G.L c.a0,SSa) t.7 Flood Zone Information: 1.8 Sewage Disposal System:
Zona: _ Outside Flood Zone? Municipal O On site disposal system O
Public Private O Check if sO P Y
SECTION 2: PROPERTY OWNERSHIP'
2.1 Owner'of Record:
�/rzScz» �eh cY /
Naine(Print) Address for Service:
Signature Telephone
SECTION 3: DESCRIPTION OF PROPOSED WORK'(cheek all that apply)
New Construction O Existing Building O Owner-Occupied O 1 Repairs(s)X I Alteration(s) Addition O
Demolition O 1 Accessory Bldg.O Number of Units Other O Specify:
Brief Description of Proposed Work':
SECTION 4: ESTIMATED CONSTRUCTION COSTS
Item Estimated Costs: Official Use Only
Labor and Materials)
1. Budding s 3 1. Building Permit Fee: s indicate how fee is determined.-
0 Standard City/Town Application Fee
2 Electrical s ❑Total Project Cost'(Item 6)x multiplier x
3 Plumbing s 2. Other Fees: s
i. Mechanical (HVAC) s — List:
S Mechanical (Fire s ,_ Total All Fees: s
ression —�—
Check No. _Check Amount: Cash Amount:_
M1SuTotal ProJect Cosl: s 33 tff ❑ Paid in Full ❑Outstanding Balance Due
�3
33
3 6o a 360
r
w r '
SECTION S: CONSTRUCTION SERVICES
5.1 Licensed Construction Super%isor(CSL) CS-- 9-? Ll LA
'• -Y� /.j/LQ>7 -AL-e-,y O License Number Eaprrauon Date
N,yac of C Hylder List CSL T
YPt Isr below)
RR
Description
A Jdresa ^ r p rA n/ p�/J Unrestricted u to)3,000 Cu. Ft.
Restricted IA2 famd Duellin Slason Onl Residential Roo(n CovermTelephone Residential Window and Sidin,7� Z23 , 2� � Residential Sohd fuel Burntn A liance Instillation
Residential Demolition
5.2 Registered Homo Improvement Contractor(HIC)
HIC Company Name or HIC Registrant Name Registration Number
Address
Expiration Date
Signature Telephone
SECTION 6:WORKERS'COMPENSATION INSURANCE AFFIDAVIT(M.G.L.c. 152.1 2SC(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.......... No...........O
SECTION 7s:OWNER AUTHORIZATION TO BE COMPLETED WHEN
OWNER'S AGENT OR CONTRACTOR APPLIES FOR BUILDING PERMIT
I �.St as Owner of the subject property hereby
authorize l to tit on my behalf,in all matters
relative to work authorized by this building permit application.
/"Z/
Si natumofwner Date
SECTION 7b:OWNEW OR AUTHORIZED AGENT DECLARATION
)• ,as Owner or Authorized Agent hereby declare
and
tits and information on the foregoing application are true and accurate, to the best of m knowledge
that the statements B B PP Y
behalf.
Print Name
Signature of Owner or Authorized Agent Date
(Signed under the arcs and penalties of nu
NOTES:
Fof
wner who obtains a building permit to do his/her own work,or an owner who hires an unregistered contractor
egistered in the Home Improvement Contractor(HIC)Program), will mg have access to the arbitralion
am or guaranty fund under M.G.L. c. 1 a2A. Other important information on the HIC Program and
truction Supervisor Licensing(CSL)can be found in 780 CMR Regulations I I O.R6 and 110.RS, respectively.
substantial work is planned, provide the information below:
n area(Sq. FI.) (including garage, finished basemenUattics,decks or porch)
g area(Sq. Ft.) Habitable room count
f fireplaces Vumber ofbedrooms
f bathrooms Number of half baths
Type of heating system Vumber of decks/porches
Typeof cooling system Enclosed Open
1 'Total Project Square Footage"may he substituted for"Total Project Cost'