27 BARR ST - BPA-2008-1067 REPLACE 16 WINDOWS The Conimomrealth of Massachusetts
i Board of Building Regulations and Standards I t)K
is Massachusetts State Building Code. 7Stl CMR. 7 edition I IS
Building Permit Application To Construct. Repair. Reno,ate Or Demolish a R, irrd.htoo n
One- or Tit vr-Family Dtrclling
This Section For Official Use Only
Building Permit N amber: Date Applied: _--
Signature: 2ovyr—
ui ng Cunnuissionei/ i ector of Buildings
SECTION 1: SITE 1 RMATION
LI Properly ]iJ�{e 1.2 Assessors Map & Parcel Numbers
I.la Is this an accepted street? yes_ no Map Number P:urel Number
1.3 Zoning information: 1.4 Property Dimensions:
Toning Duuicl 'Prop,.:, eJ Ulx l i is pica(-sq !t .---. F,.mr.,ge iit)
rL5 Building Setbacks (ft)
Front Yard Side Yards Rear Yard
F
Required Provide) Required Provided Require) PruvidrJ
1.6 Water Supply: (M.G.L c. 40. §54) 1.7 Flood Zone Information: 1.8 Sewage Disposal System:
Zone: Outside Flood Zone•'
Public ❑ Private ❑ _ Check if yes❑ P Munici al ❑ On site Disposal system ❑
SECTION 2: PROPERTY OWNERSHIP'
Ow e t o Na -77
Name (Print) Address for Service:
Signature Telephone
SECTION 3: DESCRIPTION OF PROPOSED WORK (check all that apply)
New Construction ❑ Existing Building ❑ Owner-Occupied ❑ Repairs(s) Alterations) ❑ Addition ❑
Demolition ❑ 1 Accessory Bldg. ❑ 1 Number of Units Other ❑ Specify:
Brief Description of Proposed Work': `—' --
--------'--- il
it
SECTION 4: ESTIMATED CONSTRUCTION COSTS
Item Estimated Costs: Official Use Only
(Labor and Materials) _
1. Building $ 25n, 1. Building Permit Fee: $ '�lndicale how fee is deterniined—J
❑Standard City/Town Application Fee
2. Electrical $ ❑Total Project Cost (Item 6) x multiplier x
i
3. Plumbing $ 2. Other Fees: $
4. Mechanical (HVAC) $ List:
5. Mechanical (Fire
Suppression) Total All Fees: S �,
Check No. �7/G Check :\mount y Cash Amnunc
6. Total Project Cost: $ aid in Full ❑ Outstanding Balance Due:
I
SECTION 5: CONSTRUCTION SERVICES
5.1 Licensed Construction Supervisor(CSL)
License Numher Expiration Dale_.
Name of CSL- Huller
List CSL'fypc Iscc hclosyl
T e Dcscri pion
1JJrees
L UnresuicleJ(Lip to 35(N)0 Cu. 1=1.i
R Restricted I:c'_ Family Duelling
Signature bt Masonn Only
RC Ra>idential Roofing C moron_
Telephone \F'S ItesiJential R`induw .ind Saline _
SF Residential Solid Fucl Burmn_ Appli:ncc Insl.d Luu ni
D Raeidential Demolition
5.2 RegisterxdalJom nmmP rim C tR[ractor (HIC)
HIC Corti al N me or HIC`RR((egi •l �`lai t Registration Number
Add
. L40I q�3 o aEf-7 Expiration baV
Signature Telephone
SECTION 6: WORKERS' COMPENSATION INSURANCE AFFIDAVIT (M.G.L. c. 152. § 2506))
Workers Compensation Insurance affidavit must be completed and submitted with this application. Failure to provide 1
this affidavit will result in the denial of the Issuance building permit.
-- --—
Signed Affidavit Attached'? Yes .......... No . _...... ❑
SECTION 7a: OWNER AUTHORIZATION TO BE COMPLETED WHEN j
OWNER'S AGENT OR CONTRACTOR APPLIES FOR BUILDING PERMIT
1, OP ( 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 ol'Owner Date
SECTII�ON'7++b: OWNEW OR AUTHORIZED AGENT DECLARATION
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.
Prin to r
P
S ignatur of Ow er or Authorized Agent Date
(St net nder the ains and enalties of er u )
NOTES:
I. 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 ai bitration
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. respectis_ely.
When substantial work is planned, provide the information below:
Total Flours area(Sq. Ft.) (including garage, finished base ment/att ics, decks or poi
I 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 deck./ porches
Type of cooling system Enclosed Open
3. "Total Project Square Footage" may be substituted forTotal Project Cost"