23 ABORN ST - B-13-59 INSTALL WINDOW; CLOSE DOOR --- I'lle C•onunontcCahill of bi:usachusells
Board of Iuilding Regulations ;aid Standards CITY OF
( t+ S1:Issachuselts State Building Code.'780 C•NIR
dill :.
Building Permit Application To Construct, Repair, Renuvate Or Demolish a
One-or Tn u-Pirniily Uu eRin•y
This Section For i llieial Use Onl
Building Permit Number: Date Applied:
Building 0I11cial(Print Muriel Si a arc Date
SECTION I:SITE INFORMATION
13Propy3 I.2 Assessurs.Hap di a e umbers
I.la Is this an acre led sweet? 'es no Map Number Purcell Number
I,] Zoning Information: Li Property Dimenslonst
/.uniny District I4ap,,,j Ilse Lot Area(sy 11) fronlaye(Ill
1.5 Building Setbacks(it)
Front Yard Side Yams Rear Yard
Required Provided Required y Provided Reyuind Provided
1.6 Witter Supply:(ii c. 40.§54) 1.7 Flood Zone Intermissions 1.3 Sewage Disposal System:
Public O Private 0 Zone: _ Outside Flood Z,
Chock ifes0 Munieiptd 0 On silo Jispusul s)stem 0
SECTION2. PROPERTYOWNERSHIPt
2.1 Owners of Record•
sv 2 Pam M o��60
N;uncll'nnU ---�--1
�/3r�aa ,Soli 7�T32 ad��y
No.and Slr#Ai rele hung
P F,nuil AJdross
SECTION J: DESCRIPTION OF PROPOSED WORKS(check all that apply)
New Construction❑ Evistitt 1 Buildiny I Owner-Occupied 0 Repairs(s) ❑ Alteratlon(s) 0 Addition 0
Demolition 0 Accessory Bldg.0 Number of Units_ Other 0 .Spccily:
Brief Description of Proposed Works:
C <
SEC ION y: ESTIMATED CONSTRUCTION COSTS
Item Estimated Costs:
ILahor and\t,terials) Oft NI Use Only
1. Building S I. Buildiny Permit Fee: S Indicate how tee is determined:
2. I'lcclrical S ❑Standard City.To„n Application Fee
1. I'lumhp,g S ❑Total Project Cosl'(Item 6)x multiplier
'. Other Fees: S_
J. \Icclianical ill\
' S \icch.mic.,l iFirc ...SSS���= JJ�K/
�o•+rcssionl S total .\IlFces: S
�
('haA No. ( he"Aillouul: l'.uh \nnnu,l:; n Total Project Cmt i "V _..._— _.._.--
lJ t'/° ❑P.uid in Full O Outslandiny I1.1Lu,ce Due:
95��
SBCrlON s: f ONSI-RIIf-•rI0N SERVu'ES
e,l C'unstructiun Sullenisur License1�'til.l S_ Q llI II.q- (Pf14 �� 1
,h,,//// I icen,e Nuulher P,poaWro I Me
SLI
N:uneol'l' Ld r Il,101. I\PClieebeil1.__.__.__— -
No. ,mJ suecl 1`2-L� (I l Inro,lriercJ I IluBJiu's li nh 1S,Illltl cu. Il.l
R RatricteJ lX2 Pdmil Dwclin
" \I 11a:on
RC Rlxnin Cuwrin
µ'S µ•ilduw,mJSidin
- qp Solid Fuel Iluming Appliances
1 InSolution
l'de hone
IOnailaddnu U Denullilian
1111 Registered Ilume Improvement Contractor(111C)
IIIC'Itegisl—nn�r c\11inniun Uutu
i iIC C,,,npah) Name or IIIC Regisuunl Nunw
):mall adJnvsa
No.and Slrol:t
role hone
Ci rrown,State ZIP
INSURANCE AFFIDAVIT(M.G.L c. 152. 25C(6))
SECTION 6:WORKERS'COMPENSATION
Workers Compensation Insurance affidavit must be completed and submitted with this application. Failure to provide
this atlidavit will result in the denial of the Issuance of the building permit.
Signed Affidavit Attached? Yes .......... O No O
SECTION 7a: OWNER AUTHO 11 RIZATION T 11 O BE COMPLETED WHEN
OWNER'S AGENT OR CONTRACTOR APPLIES FOR BUILDING PERM1IIT
I, 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.
Oute
print O„ner's Nunne(Eleclrunie Signuture)
SECTION 7b:OWNER' OR AUTtIORIZED AGENT DECLARATION
By entering my name below, I hereby attest under the pains and penalties of perjury that all of the information
conta'ned in this application is true and accurate?the best of my knowledge and understanding.
n ic:Sim oral Dute
Prim Owner'eur:\ulhorind, tau•. ;uoe e� U '
NoTESt
I. An Owner who m
ho obtains a building perit to do his.her own work,or an owner who hires an unregistered comractur
registered in the Hw d uner\I.
ne Improvement Contractor(HIC) Progransl,will r o have access to the arbitration
(,lot t fundG.L.c. IJ_'A. Other inhponant information on the HIC Program can be liwnd at
program u in
I information on the Construction Supenisor License can be found at
substantial work is planned, provide the iN°fIiltctludinglovage, finished basement attics.decks or porch)
total flour area(sy. 11.) - --- Habitable room count
Gros;his ing areal sy. 11.) .... _.... . -- Number ul heJruums _
\unlhcroFtircplaces -. .. -- \umberofilallhaths
\umher of bathrooms - Number of decks pordles
I\pc of leaning i),lellh I,nco,eJ ..Open
I'\Pe p1 e0P1 n111 i\Aelll
1 -1*oial l'mjeo \,lucre l"J++1,14C Ilt;l\ he alMliuncJ lilr"I'olal I'rojecl�'+"t"