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20 BARSTOW ST - BPA-2010-283 13 REPLACEMENT WINDOWS
The Commonwealth of Massachusetts Board of Building Regulations and Standards =ovis Massachusetts State Building Code,780 CMR, 7" edition Building Permit Application To Construct, Repair, Renovate Or DeOne-or Two-Family DvyelZing t Section For Official Use Only' B i ingPermitNumber: Date pplied: S gitature: Building Commissioner/ pro - it Dam SEC IO 1.S TE II�TFORMATION 1.1 Pro erty Address: 1.2.4ssessorsMap 8 Parcel Numbers �© �ad'Slvw 1.1 a Is this an accepted street?yes= no Map Number Parcel Number 1.3 Zoninglnformation: 1.4 Property Dimensions: Zoning District , Proposed Use Lot Area(sq ft) Frontage(4) 1.5 Building Setbacks (ft) - - Front Yard Side Yards - - RearYard ' Required Provided - Required Provided I Required Provided anon: I.S Sewage Disposal S stems 1:6 Water Supply: M.G.L c.40 54 1.7:Flood Zone Inform � P Y PPY ( , �. ) Zone: - Outside Flood Zone? System- Public❑' Private❑ — Check if yes❑ I Municipal❑ On site disposal system ❑ SECTION 2: PROPERTY 0\W ERSFIIPt p 2.1 0wriero1'Rec ord: ord: C,r,d 0 W eti. Br4r S G Gt �(� O Name(Print) Address for Service: - Signature - Telephone SECTION 3o-DE'SCRIPTION OF PROPOSE➢WORD ' (check all that apply) ❑ �•.`.'n fa .:p:cd ❑ I R'epa S(5')'._ A I .:L`n( ). Ad iti�cln [2 Demolition ❑ I Acre B ❑ Nibcrofllnits___ Oth spcf;: . ,. Brief llcscripiion of l u AnAX-1C., z, SECTION 4: ESTIMATED CONSTRUCTION COSTS Official Use Only Item Estimated Costs: 0 y (Labor and Materials 1.Building S 1. Building Permit Fee:S Indicate how fee is determined: Cn . ❑Standard City/Town Application Fee o.Electrical a — ❑Total Project Cost Item 6)x multiplier x 3.Plumbing I S 2. Other Fees: S 4..Me6anical (HVAC) S List. 5.Mechanical (Fire $ Suppression) Tota]All Fees: S Check No. Check Amount: Cash Amount: o.Total Project Cost: S 1`{I �� ( ❑Paid in Full Eloutstanding Ba]ance Due: , , SECTION 5: CONSTRUCTION SE ES . 5.1 Licensed Construction Supervisor(CSL) q ot - -CC7 License Number Expiration Date. Frame of CSL-Holder . n 9 p t( t7� i S S 4--- I�o({G �qUw Gy si List CSL Type(s blow) l t ddress Type - `' Description - � U Unrestl ted(uo to 35,000 Cu.Ft) Signature R Restricted 1&2 Family Dwelling C Ot M- Masonry Only RC Residential Roofing Covering - Telephone. WS Residential Window and Siding' - SF Residential Solid Fuel Burning Aonliance Installation D Residential Demolition, 2 Rep stered Home 1 pro�ement C ntra for(HIC) �,�Ct Ut ✓te-�+�"l tact�l Yt�C,t n 1 �j .�;r�ti do% HIC Company Name or m Reistra(ion Number. ]C Registrant Name Registration O O rtss O g rf�., Expiration Data Signatur� Telephone . SECTION 6:WORKERS, COI ri-PFNrSATIIiON iNSUMANCE AFFFED.4VIT(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 ...........dp/, No.... SECTION Tat AWI\TER A UT-110 ZATION T.O BE-0011"riPLETEB _ O�TI\TER'S'A�'ENVOI::'CONTZ�":£.'.TARAPPLIESEOF�BIIILDYTT.G°:YE`Rl(4$T - I, as Owner of the subject property hereby . authori:,e to act on my behalf,in all matters relative to work authorized by this buildu g permit application. . Signature of Owner Date - (� -SECTION 7-b,.-GWI\T R':OR4U1H0R1 4�EIk�.I?ECF�4T1'4gIOIxt } ! Y 'ex Edi/�_5u1v r by<t.cl to dlat the statcmerits and information brit�r r]1_'om appil application are NE a sd aCCLA'ate,to the heel of nl h lo-T']eL�e"slid bell r, C, Sigriature of Owner or e > oen Date (Signed under[he ains an -rralries of➢eriury NOTES: L 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 und=M..G.L. c. 1?2A.Other important information on the HIC Pro;aril and Construction Supervisor Licensing(CSL)can be found in 780`C]vIIt Regulations 110.R6 and 110.R5,respect ugly. 2. When substantial work is planned,provide the information below: Total floors area(Sq.Ft.). (including garage, finished bastnimt/attics, decks or porch) Gross living area(Sq,Ft.) Habitable room count Number of fireplaces Number of bedrooms Number ofbathroors Number ofhalf/baths 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 Cesf'