23 APPLETON ST - BPA-13-244 ROOFING I'he Commonwealth of Ibi;usuchusctts
Board of Building ,\L
Regulations and Standards CI' L OF
5li\I
Massachusetts State Building Code, 750 CMR
,you• He ri.teJ 16rr'rill
1uilding Pcrmit i\ppiication 'ro construct. Repair, Rcnuvate Or Demolish a
One-fir Tnvi-Pimril: D lin,�r
This Section Fur prlrloal Use OI '
Building Permit Number: ' a App ' :&AAp
— -- r2r..0 --�75
Building 011icial(Print Mane) Sodurc Date
SECTION I:SITE NFORNIATION
1.1 Proper Ad rest: 1.I Assessors.Hap S Parcel Numbers
4 b .;17-0 . _51r— _
I.la Is this a�a led street?yes no Map Number Purcel Nwnher
1.3 Zoning Information. 1.4 Property Dimensions:
/uning District Irnrpowd Use Lot Area(sy Ill Frontage(11)
1.5 Building Setbacks(R)
Frunt Yard Side Yards Rear Yard
Required I'ruvided Rayuircd Provided Required Provided
1.6 Water Supply:(M.G.I.V.40.§54) 1.7 Flood Zone Information: I.!Sewage Disposal System:
Public O Private O Zona: _ Outside Flood"Luna? Municipal❑ On site disposal s)seem O
Check if yesO
SECTION2: PROPERTY OWNERSHIP"
2.1 Ownerl of Record:
L-Yry 3AC-ym MA
Name(Print) City.State,ZIP
314 B u F61.,,,, 6 0 J 8 y36
No.and Street relephune Email Address
SECTION]: DESCRIPTION OF PROPOSED WORK"(check all that apply)
New Construction O E.xisting Buildi Owner-Occupied ❑ Repairs(s Iterallon(s) ❑ 1 Addition O
Demolition ❑ 1 Accessory Bldg. ❑ 1 Number of Units_ Other ❑ .Specily:
Brief Description of Proposed Work-: T
SECTION J: ESTIMATED CONSTRUCTION COSTS
Item Estimated Costs: Official Use Only
I Labor and.Materia9l
1. Building $ l1oQ0O I. Building Permit Fee: S Indicate how ree is determined:
❑Standard City'Tuwn Application Fee
2. I:'Icarical $ t
❑Tutnl Project C'usl (hem 6).1 multiplier
I 11'lunlhing S 2. Usher Fees: S.
1. \Iech.micdl III\ \('1 S List:._
'5' Vcchanic.11 IPrrc S ------ - -- --- -- -- .. ._ . ._
ve>slonl ratai \II Fees: S_..___—_--
l'hak Na. ( heck:\nunnit: l'.I,h \Inane
f. 1'11131 Project Cnvt $ o _. .._..
®80 0 Paid in Full ❑Oulslaoding 11a1•mce Due:
SEA"PION S: CONS7'Ri1CTION SEMI( FS
5.1 ('onstructiunSupcnisurl.iccnse((Sl.)
,,LJ—C�-I11j.C,�./_S.. ..-_ —_ I icenx \'unnhcr Inspiration D:ue .
\',uneul'C.\L Ihldrt
s �k� —sellls�e >_ ` _�P 1.bQDl I•+� Ikirripli,in
Ml alid.sine(
e/ ,/� ,, 1 p �, 11 Ilnrviirieted IIhulJin s a In Ii,I11W❑1. It
�scr-.4 �Jt�A�J-..�._�—i__l •-`— It RntricicJ Ll•11'.Imil D++dlin
l'in i I'oe n,Auae.
RC Rlntin C'm erin
...—. AS Window and SiJin
SF Solid Fuel Ilurning Appliances
I Insulation
l'cic hone f:ou+il address 1) Demolition
3.2y Registered Most Improvement Contractor(HIC)
a.._r" IIIC Registration Ntunker .I(vspiniliunn Daatti
IIIC C'ompan Name nr I IIC'Itcyislmm N nw
3- c a7 �o.r ST E�Q
N Street \ pl �J7gS31$'�3�Q Entail address
Ci !Town,State,ZIP rele hone
SECTION 6:WORKERS'COMPENSATION INSURANCE AFFIDAVIT(M,G.L.c. 152. 1 I5C(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.......... C3 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.
Print Umiei s Name(Electrunic.Signature) Date
SECTION 7b: 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 the best of my knowledge and understanding.
I'riN Qwner i ar: nhorired. ycm . Nnnw Ili lectrunic Siynaulre) ale
Nam:
I. .\n Owner who ublains a building permit to do his her own work,ur an owner who hires an unregistered cuntractur
(nut registered in the Hume Improvement Contractor(HICt Program),will nu have access to the arbitration
program or guarmty turd under.M.G.L. c. 112A. Other important information on the HIC Program can be found at
N+s 111.1" ,.+ 1 information an the Construction Supervisor License can be found at
2. \\'hen substantial work is planned, provide the intunnatiun blow:
focal Iloor area 114. 111 - _____._1 including garage, lmishcd basement anies, decks or por0i)
crosiliviogarealiy. it.t ..... .._ .... . .. flabitablerounscuunt
1 \unnc�r of lirepioces Number of bcdruomi .. ... . .. . .... .
\uolhcrofhathrrmni - . . -- - _ --- \umberofhalthathi
I\pe of he,ning i)+lent \umher of'dccks ponies
I+e I1110"'ed OI+ell
1 1 "I'1a.11 Prllled equate f ool.1" I11;1\ he •ahitmjwd fur I Dial Project C o)t'