83 ALMEDA ST - BPA-14-634 STRIP & REROOF 1
L1 q 4 2
The Commonwealth of Massachusetts [SA
ITY OF
Board of Building Regulations and Standards LEbl
ivlassachusetts State Building Code, 730 CNIR ed.tlar 2011
r
Building Permit Application To Construct, Repair, Renovate Or Demolish a
One-or Tivo-Family Divelbiq
This Section For Official Use Onl
Building Permit Number: Date Applied: Z —
ILA
Building Olticial(Print Name). Signa a Date
SECTION 1:SITE INFOR,NIATION
Li raperty address: 1.2 Assessors Dlap& Parcel Numbers
�Il+irclg 5� kl
I.1 a Is this an accepted street?yes no M1l7p Numbcr Parcel Number
1.3 Zoning Information: 1.4 Property Dimensions:
i
Zoning District Proposed Use Lot Area(sq It) Frontage(It)
I
1.3 Building Setbacks(ft)
Front Yard Side Yards Rear Yard
Requircd 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:
Zone: _ Outside Flood Zone? Municipal❑ On site disposal system ❑
Public O Private❑ Check if es❑ P P y
SECTION2. PROPERTY OWNERSHIP"
2.1 QQwnerl of Record:
scinR1 Madhif.. eSICl ✓14 Q147a
throe(Print) City,Stale,ZIP
gf76 o%o 740y
No.mrJ Street Telephone Email Address
SECTION 3: DESCRIPTION OF PROPOSED WORKS(check all that apply)
New Construction❑ Existing Building Owner-Occupied 6 1 Repairs(s) ❑ 1 Alterntion(s) ❑ 1 Addition ❑ J
Demolition ❑ Accessory Bldg.❑ Number of Units--L— I Other ❑ Specify:
Brief Dascri��ttion of Proposed Work-:
SFr ;posed
h
SECTION d: ESTIMATED CONSTRUCTION COSTS
Item Estimated Costs: Official Use Only
Labor and blatcrials
I, Building $ 16 U I. Building Permit Fee:$ Indicate how fee is determined:
❑Standard Cityfrown Application Fee
2. Electrical S ❑Total Project Costa(Item 6)x multiplier x
3. Plumbing S ?. Other Fees: .S
l.,llcchanical (HVAC) I $ List:
--
Suppression)e (Fire S rutal All Fees:S
C'Ireek No._C'hcck Amount: C:uh:\mount:_
6. Total Project Cost: 13 Paid in Full 11 Outstanding Bakince Due:
SECTION 5: CONSTRUCTION SERVICES
5.1 Construction Supervisor License(CSL) 6(�3!/ / /S //(o
T h 5.,.;H1 l pA & t/�p l'QiM�F�riro License Number Expiration Dane
Nmnc of CSL Holder List CSL'rype(see below) C I
'type Description
No. and Street
,y �A U Unrestricted(Buildings u to 35,000 cu. It.)
"rGV!� /!�j R Resuicted l&2 Family Dwellin
C'ityfrown,State,ZIP tM Masonry
RC Rooting Covering
WS Window and Siding
SF Solid Fuel Burning Applianees
7T4 31p� . L I Insulation
D Demolition
ruie hone Frail address
5.2 Registered Home Improvement Contractor(It IC) 18�15—
v1 hp Ve(- IQJL tin HIC Registration Number Expiration Date
II ompan Name or HIC Registrar Name
No.. ;t(i�:ucet ya13 `7�f .3�iI� 3C(S2 Email address
f Cit /'town,Slate ZIP 'tole horn
SECTION 6:WORKERS'COMPENSATION INSURANCE AFFIDAVIT(M.G.L.c. 152.§ 25C(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...........❑
SECTION 7a:OWNER AUTHORIZATION TO ISE COMPLETED WHEN:
OWNER'S AGENTOR CONTRACTOR APPLIES FOR BUILDING PERMIT"
I,as Owner of the subject property,hereby authorize I-
t9 act on my behalf,in all matters relative to work authorized by this building permit application.
Print Owner's Mane(Electronic Signature) Date
SECTION 7b:OWNEW 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 a [i ation is true and accurate to the best of my knowledge and understanding.
L
Print Owner's or Au t 'th rized Ages Name(Electronic Sigtmture) Date
NOTES:
1. 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(I11C) Program),will nnr have access to the arbitration
program or guaranty fund under I.G.L.c. 142A.Other important information on the HIC Program can be found at
www.nutss. col � Information on the Construction Supervisor License can be found at% w.mass.�,ov:',Ips
-!.---Nv-J-1c`n-substantial work is planned,provide the information below:
Total fluor area(sq. It.) (including garage, finished basementlattics,decks or porch)
Gross living area(sq. It.) Habitable room count
Number of fireplaces. `lumber of bedrooms
Number of bathrooms Number of hadflbaths
Type of heating system Number of decks/porches
TypeofcoolingSystem Enclosed Open_
1. -l'utal Project Square Footage"may be substituted titr"total Project Cost"