10 BARTON ST - BPA-12-819 NEW KITCHEN iusPELT ONALE�RVICES
The Commonwealth of Massachusetts 4C>I
Board of Building Regulations and Standards la'U L
Massachusetts State Building Code, 780 CMR Revised Mar 2011
Building Permit Application To Construct,Repair,Renovate Or Demolish a
C}� One-or Two-Family Dwelling
This Section For Official Use Only
Building Permit Number: Date A lied:
Building Official(Print Name) Signature Date
( SECTION 1:SITE INFORMATION
1.1 Property essC S� 1.2 Assessors Map&Parcel Numbers
m
' 1.1 a is this an accepted street?yes_ no Map Number Parcel Number
13 Zoning information: 1.4 Property Dimensions:
Zoning District Proposed Use Lot Arca(sq it) Frontage(ft)
1.5 Building Setbacks(ft)
Front Yard Side Yards Rear Yard
Required Provided Required Provided Required Provided
1.6 Water Supply:(M.G.L c.40,§54) 1.7 Flood Zone Information: 1.8 Sewage
Disposal System:Itl
Public lPrivate❑ Zone: _ Outside Flood Zone'? Municipal cJ On site disposal system ❑
Check if yes❑
SECTION 2: PROPERTY OWNERSHIP'
2.1 Owner'of Record:
13tfln. 0/470
Name(Print) City,State,21P
BAB-law ST M2979 - 32 89
No.and Street Telephone Email Address
SECTION 3:DESCRIPTION OF PROPOSED WORK=(check all that apply)
New Construction ❑ Existing Building Owner-Occupied IBS I Repairs(s) ❑ Alteration(s) Id I Addition ❑
Demolition ❑ Accessory Bldg.❑ 1 Number of Units 2i 1 Other ❑ Specify:
Brief Description of Proposed Work : 1✓F-fV KrTG ✓'i e/2,ar 1✓
CbaWftvvl 4- 75Gx- 44,w T4zwY�/z t?4bo/+r S
At 9os�
SECTION 4:ESTIMATED CONSTRUCTION COSTS
Item Estimated Costs:
(Labor and Materials) Official Use Only
1.Building $ Z b3' 7o-C) , Ell—) 1. Building Permit Fee:$ Indicate how fee is determined:
- E3 Standard City/Town Application Fee
2.Electrical $ 3 r 5I9v - le.> ❑Total Project Cost'(Item 6)x multiplier x
3.Plumbing $ 2,Sev ULD 2. Other Fees: $
4.Mechanical (HVAC) $ List:
5.Mechanical (Fire $
Suppression) Total All Fees:$
Check No. Check Amount: Casb Amount:
6.Total Project Cost: $ 3�,700- a ❑Paid in Full ❑Outstanding Balance Due:
MTN, m Iz I S
SECTION 5: CONSTRUCTION SERVICES
5.1 Construction Supervisor License(CSL)
so9>`i/ .5
R®az uli b(r(JC Iji (Q License Number Expira on Date
Name of CSL Holder
List CSL Type(see below)
vLNo ,7 W PV V Ave—
No.
.and Street Type Description
c t„ d 19-7� U Unrestricted(Buildingsto 35,000 cu.ft.
R Restricted 1&2 Family Dwelling
City/Town,State,ZIP M Mason
ry
RC Routing Covering
WS Window and Siding
,3'�-9j Z• �.-��t[ B (�(�Qo�yjf,. :11�� SF Solid Fuel Burning Appliances
T I Insulation
Telephone Email address D Demolition
5.2 Registered Homme Improvement Contractor(HIC) J,o Z 460
/?,9,9,-0- V��G�g K' HIC Registration Number E va on Date
HIC
f yme or HIC ame
/'lrrr/Dcolwgi�vc—
c� f3fsh 00'a,
t�,��,t` {x/14 619 70 gas 93Z SS / Email address
Ci /Town,State,ZIP Telephone
SECTION 6:WORKERS'COMPENSATION INSURANCE AFFIDAVIT(M.G.L.a 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 ..........O No...........Ltr
SECTION 7a:OWNER AUTHORIZATION TO BE COMPLETED WHEN
OWNER'S AGENT OR CONTRACTOR APPLIES FOR BUILDING PERMIT
1,as Owner of the subject property,hereby authorize Lam'4-U
to act on my behalf,in all matters relative to work authorized by this building permit application.
gem
Print Owner's Name(Electronic Signature) Date
SECTION 7b:OWNEW OR AUTHORIZED AGENT DECLARATION
�Q 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 a and a to best of my knowledge and understanding.
Print Owner's or Authorize Agent's Name(Electronic Signature) Date
NOTES:
1. 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 under M.G.L.c. 142A.Other important information on the HIC Program can be found at
www.mass.gov/oca Information on the Construction Supervisor License can be found at www.mass. oe v/dM
2. When substantial work is planned,provide the information below:
Total floor area(sq.fL) (including garage,finished basement/attics,decks or porch)
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 decks/porches
Type of cooling system Enclosed Open
3. "Total Project Square Footage"maybe substituted for"Total Project Cost"