46 BARR ST - BPA-12-601 MAKE BATH HANDICAP ACCESSIBLE I'he C'onunonwealth or Massachusetts
}� Board or Building Regulations and Standards Cl FY OF
t Massachusetts State Building Code. 780 C1MR SALE\I
�•�.• RrriseJ.11rx•:Il//
Building Permit Application 'ro construct, Repair, Renovate Or Demolish a
One-or rmw-Fan 1v Du elliup
This Section For Official Use Only
Building Permit Number: Dale Appiicd: _
\G1tAA44-, Lvr -7- o Zol
Building Official(Print Niune) Signature polo
SECTION I:SITE INFORMATION
I.I.Property
lt�A - , ,ddress: 1.2 Assessors.Map& Parcel Number
4 � Er -
I.la Is this an accepted street?yes no Map Number Purcel Number
1.3 Zoning Information: 1.4 Property Dimensions:
Zoning District Proposed Use Lot Area IN It) Frontage(11)
1.5 Building Setbacks(R)
Front Yard Side Yards Rear Yard
Required Provided Required Provided Required Provided
1.6 Water Supply:(M.G.I.c.JQ,§Sa) 1.7 Flood Zone Information: 1.8 Sewage Dlspc System:
Public❑ Private❑ Zone: _ Outside FlaodLune? Munici al❑ On site dis
Check;r.—n p pawls)slem ❑
SECTION2: PROPERTY OWNERSHIP'
2.1 Owner'of Record:
A-14o/-11 flMAi"isco $Au'a-t ill
Nmnc(Prm)
C uy.Stare.Zip
f�6 d Street Ri-4Q 5-1. FK% q%5- 3 I% 98y
No.an Telephone Email Address
SECTION 3: DESCRIPTION OF PROPOSED WORK'(check all that apply)
New Construction❑ Existing Building❑ Owner-Occupied ❑ 1 Repairs(s) ❑ 1 Alteration(s) O Addition ❑
Demolition ❑ Accessory Bldg.❑ I
INumber of Units_ Other ❑"Ip�,
Brief Description of ProposedWork': C-F!AA16e- G- irl—lALC S-h/o
S lfo u-'t=dt LdlnC-tip 3 bn5J&-S CEA'Hnt 'T/CC
SECTION 4: ESTIMATED CONSTRUCTION C
Item
177
Officia
I. Building 1. Building Permit Fee: S Indicate how fee is determined:
L_Electrical ❑Standard CityiTuwn Application Fee
❑Total Project Cori'(Item 6)x multi her), Pluntb10g Other Fees: SPa. Mcchunical III\' W List: A
�. \lechanical (Fire — -- --- - C� -
Su1tr0ii0u) S Total All Fees: S____----- ...._.. .
('heck No. _('heck:Umount _ Cush \mount:
o. Total Project Cost: S fL� �st?' co ❑Paid in Full ❑OutsCutding Bahmce Doc
SEX FION 5: CONS'I'RticrION SFRVICF.S
5.1 Construction 5upervisor License(CSL)
40C- A10 V/fY/f-MA-A-1104�i(9 License Nmnhcr I \piralion Uule
Nomc��fi'.<L—i Fohd-cr --.
I isl CSI. I)pe Liee hclua 1-__._D—._._—
J-9—_l r/ /<tTAJ Jai iltrtam
Na. .utJSlreel pe Oesaripliun
�L. U unrestricted Uluildin,s u l0 15,000 cu. 1l.)
.ki-L --dtj� ��. 0R Restricted IX2 Find DswllinCitsi town,SLuc./II' 11 MasonC' Rnolin Cocerin'S Window;md SidinF Solid Fuel Burning AppliancesI InsulationTelc hone Demolition it
5.2 Registered Home Improvement Contractor(HIC) Jy3671 -7 .20_12
�'CcMt18 IIIC'Registration Numher Expiration Date
I IIC'Company Name or l IIC'Ittgistrant Name
No.;md SLp1wet 9 Email address
P1 R C;s)y4S 781�yS a76
City/Town,State,ZIP rele hone
SECTION 6:WORKERS'COMPENSATION INSURANCE AFFIDAVIT(M.G.L c. 152. 4 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...........O
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.
Print Owner's Nmne(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 application is true and accurate to the best of my knowledge and understanding.
1-ociAyis i)1e1e_1W,1AJt0A)t0 /.r(� . /�;t-
Print Owner's or Autlnrircd Agcnt's Name I Flaclrunic Siguat re) Date
NOTES:
F(no
Oner who obtains a building permit to do his.her own work,oran owner who hires an unregistered contractor
wt registered in the Hume Improvement Contractor(HIC) Program),will no have access to the arbitration
gram or guaranty fund under M.G.L.c. IJ?.A.Other important information on the HIC Program can be found at
o (1i.r•s ,t ,v.t Information on the Construction Supervisor License can be found at nt.ts,�pc Jp,
2. When substantial work is phmned, provide the iit formal ion below:
Total (lour area Isy. 11.) _ (including garage, finished basement attics.decks or por6i
Gross living area Isy. 11.) __- ..__ __.. Habitable room count
INumber of fireplaces_-.. ..._ Numberolbedrooms
Number of hathroums .. . . \'umber of halt halhs
I%pe of heating sy stem Number otdecks, porches -
i
I" pe t l coining sy stem Inclosed _ Open
1. "r,aal Project Stluare Footage"may he Substituted thr"Filial Project Cbsl"