7 ALLEN ST - BPS-26-1234 EXTERIOR UPDATES ' r ,
GiaSi l �tz'f y 3�3 �Ll
The Commonwealth of Massachusetts '
Board of Building Regulations and Standards t4s,'t )i M
(f) Massachusetts State Building Code,780 CMR Revised Mar 2g
Building Permit Application To Construct,Repair,Renovate Or Demolistlb Ef
One-or T1vo-Family Dwelling
7�SectjonFor C11Sc�Use Onl •:
i Building
Potffi+it.I Fumbe� . Die App]ied:
Date
SWOON 1 SITE TION
1.1�py�o(/1��r�j[yyy AddrpSCg ' C 1.2 As
Map&Parcel Numbers
L la 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 ft) Frontage(ft)
1.5 Building Setbacks(11)
From Yard Side Yards Rear Yard
Required Provided Required Provided Required Provided
1.6 Water Supply:(M.G.L c:4%§54) 1.7 Flood Zone Information: 1.8 Sewage Disposal System:
Zone: Outside Flood Zone? Municipal 0 On site disposal system 0
Public❑ Private O — Check if yeso
SECTION 2- PR4)P$RTPUWNERSB
2.1 ertotRecord• � 1 �/
Name(Print) City,State,ZiP
7 41tztq V y �Y3083D kern `l u va Ljdo.c�h
No.and Street Telephone Email Ad s
1 SECTION 3:DESCR]<PTION.OF PROPOSED WORK'(4lreek all ttiat apPIY)
New Construction 0 Existing Building❑ Owner-Occupied Repatrs(s) ❑ Altera"on(s) ❑ Addition ❑
Demolition 0 Accessory Bldg.❑ Number of Units Other ❑ Specify:
B 'ef lescription of Propo World r
i
ON 4:ESTBYIA CONSTRUCTION COSTS
Estimated Costs: Official Use Only
Item (Labor and Materials
1.Building $ _ 1, Buih#ng Permit Fen:$ Indkxte how fee is determim
0 Standard City/Town Application Fee
2.Electrical $ O Total Project Cosy'(Rem 6)x multiplier x
3.Plumbing $ 2. Other Fees:
4.Mechanical (HVAC) $ List:
5.Mechanical (Fire ression $ Fotai AB Fees:$
u
Check No. Cheek Amoutd:
S Cash Amount. .
6.Total Project Cost: $ 5�, 0 Paid in Full. 0 Outstanding Balance Due.
M f1kl t_k�cr? TD 1 t O 1 Z,--1
10
a>cTlon 5.
CONSTRuMON sl Rvrc s
5.1 Construction Supervisor License(CSL)
r. . License Number Expiration Date
Name of CSL'Holder,
List CSL Type(see below)
No.and Street T)ie Description.
U I Unrestricted(Buildings to 35,000 cu.R
R I Restricted l&2 Family
Cityfrown,State,ZIP M Masonry
RC Roofing Coveria
WS Window and Si
SF Solid Fuel Burning Appliances
I Insulation
Telephone Email address D Demolition
5.2 Registered Home Improvement Contractor(HIC)
HIC Registration Number Expiration Date
HIC Company Name or HIC Registrant Name
No.and Surest Entail address
Ci rrown State ZIP Tel one
SECTION 6.WORKERS COMFE VSAnON INSURANCE AFMAYIT(A7.G.L.e.152.4 25 3)
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 AUT116RIZAtION TO k COWLMI)Vl'im-
OWNER'S OR CO' OR ING PMM
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.
Print Owner's Name(Electronic Signature) Date
SECTION 76:OWNER`OR AUTHORIZED AGENT DECLARATION
By entering my name below,I hereby attest under the pains and penalties of perjury that all of the information
contained in this application is true and accurate to best of my dge and understanding.
/O--2Z-(6
Prillt-Mrier's or Authorized Agent's Name le ) Date
1. An Owner who obtains a building permit to do his/her owjm6rk,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 can be found at
jMMjass. og vtoca Information on the Construction Supervisor License can be found at MM .mass.gov/dos
2. When substantial work is planned,provide the information below:
Total floor area(sq.it.) (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
3. "Total Project Square Footage"may be substituted for"Total Project Cost"