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20 BARSTOW ST - BPA-13-511 11 REPLACEMENT WINDOWS Jzk The Commonwealth of Massachusetts " Board of Building Regulations and Standards FOR Massachusetts State'Buildin Code 7.80 C h .MiJNICIPALITY.. g MR, 7 edition USE. Building Permit Application To Construct,Repair,Renovate Or Demolish a Revised January. " One-or Two-Famfly Dwelling 1, 2008 711is'Sen6011 For Of5cial a Onl Buildine,Permit Number Date pplied: �\ 0.4 Signature: 3 Building Commissioner/Inspector ofBu gs SECTION I:SITE O ATION 1hPor op=:' ap &Parcel Numbers . ssessors 1.1 a Is this an accepted street?yes_ no Mep Number Parcel Number. 13 Zonetng�Information: 1.4 Property Dimensions: Zoning District Proposed Use A Lot Area(sq ft) - Frontage(4) 1.5 Building Setbacks (ft). -Front Yard Side Ynids Rear Yard Required . Provided Rtqu,7md - Provided Required Provided - L6 Water Supply: (M-G.L e.40, §54) 1.7'Flood Zone Information:--. 1.8 Sewage Disposal.System:.:- -- Zone Outside Flood Zone?.. Public❑' Private❑ — Municipal❑ On site disposal system [I Cheek ifycsO SECTION 2: .PROPERTY OVaiERS11][I" 2.1 /O�wnert of eeord: G&I � Owee' s :20 CR41c) Name(Print). Address for Service: •- Signature .. - Telephone SECTION 3:9FSQ2IPTION OF PROPOSED WORK2'�cheak all that,apply) Jsea•'Com^.tzn�ica ❑ 'EAisc.ng]?u'cFdi:Yg, Ocher--�^ upled $epais(s)''. ;:1ti:�ticn(s) �' Additicn C Deniolitinn ❑ Accnssnry Bldg:❑ ilumber of I Inits Other. E Spccifg:_.-,4e: 1,Gc ,- Brief Description of Proposed Work'-: 'zp . ll isl t-x al (tom SLTIJ e-T7J 6t l C a� .C" . SECTION 4:ESTIMATED CONSTRUCTION COSTS Item Estimated Costs: Official Use Only (Labor and Materials) 1,Building $ 1. Building Permit Fee:$ Indicate how fee is determined: 2.Electrical g ❑Standard City/Town Application Fee ' O Total Project Cost? (Item 6)x multiplier x 3.Plumbing $ 2. Other Fees: $ 4.Mechanical (HVAC) $ List 5.Mechanical (Fire Su pression) $ Total All Fees: $ Check No. Check Amount: Cash Amount: 6,Total Project Cost: $. J 3 ?Y3 dp 0 Paid in Full ❑Outstanding Balance Due: SECTIONS_ CONSTRUMQN-SPRUCES s 5.1 Licensed Consti-nction Supervisor(CSL) . 8ef\At •�,,•� License Number Expiration Date. Name of CS I,Hold 1 D,.` eif Li stCSL Type(seebelow) _ . Address Q! d /- -. U Unrestricted(up to 35,000 Cu.FL) Signaturc - - R Resuictcd 1&2 Family Dwelling ✓`fig �1 1- <�Ck� . .. _ TvI Masonry.Only - Telephone. RC Residential RootingCoven n - - . -�( S.�aD' .WS' Residential VrrmdDW and Siding— , SF Residential Solid Fuel Binning Appliance Installation D - .Residential Demolition 5.2 rgistered'Ho a lm rov ent Contractor(IIIC) HIC Company Name or H C Regisnaht N�n e Registration Number . Addresses Expiration Date . $ignaturo_' _ Telephone . . '. SECTION 6:WORKERS' COMPENSATION INSURANCE A207IDAVIT(M.G.L.c:152_§ 35C(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 budding permit Signed Affidavit Attached? ' Yes a.-- No..........❑ " SECTION ZB OVRi ER'�Z3TKbk2JZATION TO BE OpMi?P ETID, N:. ©�VN£�R'S AGENI'�1�CANT&ACT'Oxt.SPPLIESItbRBI]II.3?�NG'F,'F]_7L11%ITT . . . I, GeL, ` 6W VtS as Owner of the subject property hereby authorize to act on my be halt;in all matters relative to work authorized by this building permit application . Signature of Owner .. - Dati J1 SZC�M 7bt WNFRt,.,R.�R> ^?� �?Tb�I�tATJON ". : l'. 1 ai n i�i yet SC az Q�ro ehnY fcit(hM¢ed Agent itety BeclSrk_ din( the.statcnzents and information en.he.f�:ceutu_ ape cauun'aretru�aisd accur�alr, to the best of niy.ktroNikdgc and . belialf. & ✓Vkk .Print Name Signature of Owner or uthdrized Agent (Signed underthe pains and penalties of e ' NOTES 1. An Owner who obtains a buildingpermit 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 liave access to the arbitration program or guaranty fund under M.G.L.c. 142A.Other important.ipfomiation 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 basemantlattics, decks or porch) Gross living area(Sq.Ft.) - Habitable room count Number of fireplaces Number of bedrooms Number ofbathroomt Number ofhaMaths Type of heating system Number of decks/porches ' Type of cooling system Enclosed Open 3. "Total Project Square Footage"maybe substitnted'for"Total Project Cost' f 3°up