25 ABORN ST - BPA-10-932 BUILD DECK AROUND HOUSE y �
The Commonwealth of Massachusetts
Board o Building Regulations and Standards CITY
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Massachusetts State Building Code, 780 CMR, 7"edition Revised J dJmnua
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Building Permit Application To Construct, Repair, Renovate Or Demolish a l• NAY
One-or Two-Family Dwelling
This Section For Official Use Only
Building Permit Numbe . A Pa App!ijd::
Signature: b
Building Cemmissioner/Insftclor of Buildings Date
SECTION 1:SIT INFORMATION
1.1 Property Address: 1.2 Assessors Map& Parcel Numbers
I.1 a 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 11) Frontage(11)
1.5 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? Municipal❑ On site disposal system ❑
Check if es❑
SECTION 2: PROPERTY OWNERSHIP'
2.1 Owner of Record: . Z S Ab0 fL I �T sQ �e Y'1') (1'1 G CC
1C SP � ✓ord: 1 Gl
Name(Print) _ Address for Service:
Ji ature Telephone
SECTION 3: DESCRIPTION OF PROPOSED WORK+(check all that apply)
New Construction Existing Building❑ Owner-Occupied Of Repairs(s) ❑ Alteration(s) ❑ Addition ❑
Demolition ❑ 1 Accessory Bldg.❑ Number of Units_ I Other ❑ Specify:
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Brief Description of Proposed Work': t t Jf
�r At
SECTION 4: ESTIMATED CONSTRUCTION COSTS
Item Estimated Costs: Official Use Only
Labor and Materials
1. Building S (� I. Building Permit Fee: S Indicate how tee is determined:
❑Standard City/Town Application Fee
2.Electrical S ❑Total Project Cost'(Item 6)x multiplier x
3. Plumbing S 2. Other Fees: S
4. Mechanical (IIVAC) S List:
5. Mechanical (Fire S Total All Fees: S
Su ression
Check No. Check Amount: Cash Amount: , '
6.Total Project Cost: S � ❑Paid in Full ❑Outstanding Balance Due:
I
17
SECTION S: CONSTRUCTION SERVICES \
5.1 Licensed Construction Supervisor(CSL)
License Number 6xpimiton Date
Name ol'C'SI.- I Ioldcr
List C'SL'1'ype(see below)
Address fs ve Description
U Unrestricted up to 35.000 Cu. Ft.
®RC
Restricted 1 @2 FamilyDwelling
Signature Mason Only
Residential Rootin Coverin
Telephone Residential Window and SidinResidential Solid Fuel Bumin A liance Installation
Residential Demolition
5.2 Registered Home Improvement Contractor(HIC)
I IIC 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 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: OWNER'OR AUTHORIZED AGENT DECLARATION
n
as Owner or Authorized Agent hereby declare
that the statements and information on the foregoing application are We and accurate,to the best of my knowledge and
behalf.
Pram
-� Az beg
gnature of owner or Authorized Agent Date
(Signed under the pains and penalties of 'u
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 gpj 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 I IO.R6 and I IO.RS, respeetively.
2. When substantial work is planned,provide the information below:
Total floors 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
J. "Total Project Square Footage"may be substituted for"Total Project Cost"