35 AURORA LN - BPA-2008-848 REPLACE PATIO DOOR 1
Zh The Commonwealth of Massachusetts
Board of Building Regulations and Standards FOR
MUNICIPALITYMassachusetts State Building Code. 780 CMR. 7'h edition
USE
Building Permit Application To Construct, Repair, Renovate Or Demolish a Reviser(Juneur_c
One- or Two-Family Dwelling 1. 2Q13
/ This Section For Official Use Only
Building Pe7ommissil
r. Date Applied:
Signature:
rr/Inspector of Buildings Date
SECTION 1: SITE INFORMATION
1.1 Property Address: 1.2 Assessors 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 R) Frontage(tt)
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:
Zone: _ Outside Flood Zone? Municipal ❑ On site disposal system ❑
Public❑ Private❑ Check if yes❑ P y
SECTION 2: PROPERTY OWNERSHIP[
2.1 Ow,Wrt of Record:,
Name(Print) Address for Service:
Signature Telephone
SECTION 3: DESCRIPTION OF PROPOSED WORK=(check all that apply)
New Construction❑ Existing Buildin Owner-Occupied ❑ 1 Repairs(s) ❑ Alteration(s) Addition ❑
Demolition ❑ Accessory Bldg. ❑ Number of Units Other ❑ Specify:
Brief Descrigtjon uf'roposed WorkZ:
SECTION 4: ESTIMATED CONSTRUCTION COSTS
Estimated Costs: Official Use Only
Item (Labor and Materials)
1. Building $ 1. Building Permit Fee: $ indicate how fee is determined:
Standard City/Town Application Fee
2. Electrical $ ❑Total Project Cost(Item 6) x multiplier x
3. Plumbing $ 2. Other Fees: $
4. Mechanical (HVAC) $ List:
5. Mechanical (Fire $ Total All Fees: $ O
Suppression)
Check No. �f Check Amount-. Cash Amuune
6. Total Project Cost: $ Paid in Full ❑Outstanding Balance Due:
SECTION 5: CONSTRUCTION SERVICES
5.1 Licensed Construction Supervisor(CSL)
License Number Expiration Date
Name o1'CSL- Holder List CSL T
ype(see below)
\ Type, I Description
Unrestricted(up to 35.000 Cu. Ft.)
R Restricted I&2 Family Dwell in
tgnature M Masonry Only
`lKC --oBL�-o RC Residential Roofing Covering
Telephone WS Residential Window and Siding
SF Residential Solid Fuel Burning Appliance Installation
1 D Residential Demolition
5.2 Registered Home ImproveContractor(HIC) / j d —7
a ;�
H IC Name orIC Registr,,ult Nye.. ,, n Registration Number
Addres ry^ r°'1W �71�-^.-7� r y�
c r `&t cr�7dv2� xpiratior Date
Signature NTelephone
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 BE COMPLETED WHEN
OWNER'S AGENT OR CONTRACTOR APPLIES FOR BUILDING PERMIT
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.
Signature of Owner Date
SECTION 7b: OWNER'OR AUTHORIZED AGENT DECLARATION
I, 5-LE ec-?A / �51 i�� , as Owner or Authorized Agent hereby declare
that the statements and information on the foregoing application are true and accurate, to the best of my knowledge and
behalf.
Print Nam^_
Signature of Owner or Authorized Agent Date
(Signed under the pains and penalties of perjury)
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(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 and
rConstruction Supervisor Licensing(CSL)can be found in 780 CMR Regulations 110.R6 and 110.115. respectively.
When substantial work is planned,provide the information below:
l Floors area(Sq. Ft.) (including garage, finished basement/attics.decks or porch)
ss living area(Sq. Ft.) Habitable room count
ber of fireplaces Number of bedrooms
ber of bathrooms Number of half%baths
e of heating system Number of decks/porches
e of cooling system Enclosed Open
3. "Total Project Square Footage" may be substituted for"Total Project Cost"