8 BARTON ST - BPA-12-819 EXTERIOR REPAIRS % l'lie C•onunonweldth of Massachusetts
g; 1� Board of Building Regulations and Standards CI'I'1'OF
��i(� 'i assachusetts State Building Code, 780 C'NIR SALE\I
l '1.,..• Krri.reJ.ILu _'lll/
lUjl Building Permit Application "fo Construct. Repair. Renovate Or Demolish u
One-ur7'uu-Fiun-1 Dvi ellitig
This Section For Otfik;W Use Only -
Building Permit Number: Da Applied:
y/-7 I
Building Official(Print Narne) Sigtmturc Dale
SECTION I:SITE INFORMATION
LI Preper JJress: 1.2 Assessors blsp.St Parcel Numbers
I.la Is this an accepted street?yes no Mop Nuntlxr Parcel Number
1.3 Zoning Information: 1.4 Property Dimensions.-
zoning District Proposed Use Lot Amu(sq 11) Fronlage(II)
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.40.§Sa) 1.7 Flood Zone Information: 1.8 Sewage Disposal System:
Public❑ Private❑ Zone: _ Outside Flood Zone?Check if es❑ Municipal❑ m On site disposal syste ❑
SECTION2: PROPERTY OWNERSHIP'
2.1 Owner of Record: �
(AVN (r.,P (�� -?n
N;une(Pnntl C'i tat ,Z.IP
(f 13,�atof.r �t 'tea
No.and Street Telephone Email Address
SECTION 3: DESCRIPTION OF PROPOSED WORK'(check all that apply)
New Construction❑ Existing Building❑ Owner-Occupied ❑ Repairs(s) ❑ 1 Alteration(s) ❑ Addition ❑
Demolition ❑ Accessory Bldg.❑ Number of Units_ Other ❑ .Specify:
Brief D scOptiono�[Proposed Work': ciJi I
SECTION 4: ESTUTATED CONSTRUCTION COSTS
Item Estimated Costs: Official Use Onl
ILabur nd .Materials) y
I. Building S 6 I. Building Permit Fee: S Indicate how fee is determined:
'. Electrical S ❑Standard City/Town Application Fee
❑Total Project('ost'I Item 6)x multiplier —.__— x
Plumbing S �, Other Fees: S —
4. Mechanical IIIC.1(') S List:_ __--
Wire
tiu+tressionl S Tutol .\II
Check Nu. ('heck Annwm: C'sh \ntoune
n Total Project Cast SaC/ ❑ P;iid in Full ❑Outstanding Balmtce Due:
VKad db
SECTION S: CONS'I-RliCTION SERVICES
5.1 'unstrucliun Supen isur Licensee((CSL) /; f7n
_ _�M t — `. _ I IEcenseCNNumbcr I\pi anim U 1¢
N;uue ol'Ctil. l)older
I is l:til. I)pe Isee
Deicription
No. and Streel
� �^c� n`^� U 14vcitrieleJ UIuilJin�s a nl is,IlOtl eu. 11)
— Lr A .�._SL203!Q . Restricted Idl•d Fanlil Daellin
Cif,illten.State.%11' NI �Iuiun
RC Rt,otin Onerin
.."_. N'S Windca ;Ind.Sidin
SF Solid Fucl Iluming Appliances
I vlc hone rnwil address D Denntlition
5.2 Registered lilucma/Impr/yt/y�/rr/YY��nnCsent Contract HIC)
�(,(,WIJCS"!/ rIk� r-CA /H (`�,� IIIC R cgistr lion Number !:%piralitIn Date
IIC• 'nnIun) Ni nw or I IIC'Registrunt Name 0
N IJ Stu: �+ r �,7 6� ):mail address
City/Town, State,ZIP A tole hone
SECTION 6:WORKERS'COMPENSATION INSURANCE AFFIDAVIT(M.G.L c. 152.S 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 7s:OWNER AUTHORIZATION TO BE COMPLETED WHEN
OWNER'S AGENT OR CONTRACTOR APPLIES FOR BUILDING PERMIT
V
I, as Owner of the subject property,hereby authorize 1 J �m L
to act on my behalf,in all matters relative to work authorized by this building permit application.
2( t f 12
II I Uwine s Nwne(Flecimni gnuturc) Date
SECTION 7b:OWNER' OR AUTHORIZED AGENT DECLARATION
By entering my name below, I hereby attest under the pains and penalties of perjury that all of the information
cons ' d in this application is tru 1 a�ccur�ate to the best of my knowledge and understanding.
Prim l (r'i or tivk ttlh IriiuJ. bent's wtic 11 Icctrunlc Slgn;numl zDatt. '
NOTES:
FI. .\:n Owner who obtains a building permit to do his,her own work,oran owner who hires an unregistered cwntraclur
t registered in the Hunte Improvement Contractor(HICI Program),willrro have access tothe arbitration
gram ur guaranty fund under.M.G.L.c. la_'A. Other intponant information on the HIC Program can be found at
,., nLns ��s '..I Information on the Construction Supervisor License can be found at,t)t"2. hen substantial work is planned,pruvide the information below:
A li,ing area liy. Il.l ____ Habiuble roum count
I \umber of fireplaces -_.... __.. .- Number of hedruomu
\%,ether of bathrooms - . _ - . \'umber of half baths ..
I"\pe al heating i)sent \timber o(decks, porches
Ianclosed Open
I I\pl tIi eOt+Illlg i\51ei11
t "foLll Project Square Footage"111;1) he suhitimucd Rtr"I'ol;d Projcct Cost"