27 BARCELONA AVE - BPA-11-407 REMODEL BATH e
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The Commonwealth of Massachusetts
Board of Building Regulations and Standards CITY
1 Massachusetts State Building Code,780 CMR,7th edition WReOvisedJarrM
uary
Building Permit Application To Co ct, pair,Kenovat emolish a 1, 2008
One-or T o-Farm! Dwelling
a Th' Section Wr ici se Only
e Building Permit Numb D Applied:
Signature: 4-710 1-0
Building Commissioner/Inspectof of Buildings Dale Cj
SECTION 1:SITE INFORMATION
1.1 Propeity Add�ss 1.2 Assessors Map&Parcel Numbers
a) % 1-34+ Y/oi`/�F c'
I.1 a Is this an accepted street?yes_✓ no Map Number Parcel Number
13 Zoning Information: 1.4 Property Dimensions:
Zoning District Proposed Use Lot Area(sq ft) Frontage(ft)
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 2'_ Private❑ Zone: — Outside Flood Zone?
Check if yes❑ Municipal B'6 site disposal system ❑
SECTION 2: PROPERTY OWNERSHIP'
2.1 Owner'of,Reco
��,,�
-�6P�-/i a > ✓�arr� o.�a
S ry Nam Print / Address for Service:
d re � ✓(�l�c/%c �� 7— e,?3 -7
Telephone
SECTION 3:DESCRIPTION OF PROPOSED WORK=(check all that apply)
New Construction❑ Existing Building Pr Owner-Occupied Repairs(s) ❑ Alteration(s) Addition ❑
Demolition ❑ Accessory Bldg.❑ Number of Units_ Other ❑ Specify:
Brief Description of Pro sed Work': Aeplatoa �ry .--e •l,e urf - Y-
zu
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5" c Lt.oY P c �w t Y'P u r✓r I
SECTION 4: ESTIMATED CONSTRUCTION OSTS
Item Estimated Costs:
Labor and Materials Official Use Only
1. Building $ 7 ry 1. Building Permit Fee:$ Indicate how fee is determined:
2.Electrical $ A15-0,Oro ❑Standard City/Town Application Fee
❑Total Project Costa(Item 6)x multiplier- x
3.Plumbing $ /ZOO-crD 2. Other Fees: $
4.Mechanical (HVAC) $ List:
5.Mechanical (Fire
Suppression) $ � Total All Fees:$
Check No. Check Amount: Cash Amount:
6.Total Project Cost: $,J(7 js'� ❑paid in Full ❑Outstanding Balance Due:
/0
SECTION 5: CONSTRUCTION SERVICES
5.1 Licensed Construction Supervisor(CSL) C►,S' 6- y3�- �" .3
&-1 A Mci C U pNa(s License Number Expiation Date
Name of CSL-Holder List CSL Type(see below)
-Z 3 q (o Po rs rhtwPA
Ad -�- T Description l U Unrestricted(up to 35,000 Cu.Ft.
R Restricted 1&2 Family Dwellin
MasonryOnly
�/- G �3� RC Residential Roofing Coveting
Telephone ID
Residential Window and Siding
SF Residential Solid Fuel BurningAppliance Installation
FD Residential Demolition
5.2 )(iP istered 41p�a royrent Contractor(HIC) z � ,. t/
/!7 7 �_ �`
HIC ompany am qr HIS Re ''stran me / Registratio Number
Ad 71z�.Q ST ®��',.��1D73P lion Date
Signa /Telephone L
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 79:OWNER AUTHORIZATION TO BE COMPLETED WHEN
OWNER'S AGENT OR CONTRACTOR APPLIES FOR BUILDING PERMIT
1, 4 S ?-p�-c, /3OV d �"s /r as Owner of the subject property hereby
authorize Are i kr t /�C 66A 00 Ay to act on my behalf,in all matters
relative to work authorized by this building permit application.
za�a
S� ature of Owner Date
�SECTION)7b:OWNER'OR AUTHORIZED AGENT DECLARATION
Ze- dew. 4a 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. �J
Print Name _
/MUV o?CYb
Nignaturd or0v9ncr or Authorized Agent Date
(Signed under the vains and penalties of
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 ng 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 110.R6 and 110.R5,respectively.
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. FL) Habitable room count
Number of fireplaces Number of bedrooms
Number of bathrooms Number of halflbaths
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'
ut 8/i 96
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