19 BEACON ST - BPA-2009-290 BACK PORCH 0 r
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13uildi112 Perms( Applicau,nl To ('onsotic(. Rcpau. Rrn+n.,(e lh Dvilloli,h ,t
Oile- rn- Tit u-1.",orlih 01"I/rrt!
Q� I his .Section For Official I1,c (h4y ----- ---- _- _"""
\\� 13ul,hnc Pcnnrt Vumher
Apphed:
RwldmF(' mtn .a,meV 111,1aLlol ill 11u Jdmg+
( Par
.SEL F:ON l: SI7'F I\FI)H%1 % I ION
\ddrtss: ---
crtr I 1 ? \uruur+ flap X Parcel ..Numhc r, -- - - -
I I ld IN this .m is cc plod ,tru(. sc,-�� n••. \L,p.1,tonhrr .__ P.•i ,I \ u:.hii
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I :.3 Zoning Informa[i+m: 1 ai
�n--%!i-r—
;micas:
Zcnu,g Dunci Use —,AreaIF4 III
Frunlagc ilir
1.5 Building Sclbacks (ft) --- - ---- -----�
i ---- Yard - Side Yards Rear 7:ud
ReyutrrJ I Pru% e_= Rd PrustJrJ Rr uurJ
4 In �Nrd
r16 ater Supply: L\4.G.L c 10. §S1) 1.7 Flood Zone Informatio,�: --- 1.8 Sewuge Dispersal System:
c ❑ Prrcate❑ Zone: _ Outside Flte)d Zone:'
_ Check it yes❑ \1u Is:1PJl ❑ On srte dtsix"al s) acill ❑
SECTION 2: PROPERTY OWNERSHIP' --�
�1 ssner'of Record:
icn�fF2o .� .
Name Pnn't Address tirr Scrvlce: —_----___
p-7 ,&
Telephone >
SSif ilON J: DESCRIPTION OF PROPOSED WORKr(check all that apply)
N" Curotrucliun ❑ Existing Budding ❑ Effikner Occupied r — - --- �
p : Hepatrst,l ❑ Allenlnonl,) ❑ rJJuum C
Dc•nulilum n 1Cce<v.try tit HI:Lt. 0Number of U: r -- ------'
_ .__ s Other ❑ Speuly i
Brief Description of Pr trn-xu
I SECTION J: ES ItitATED CONSTRUCTION COSTS
Ilan Estimated Cass. -- -�
if ahor and %lat al,) Official Use Only —
I BuJJme g L BuJding Permu hre: 5 /J_ . IrJtrale buss ti•c t, Jcict nuncd. I
'. Flectrtcal g ❑ Standard CIty/Town Application I"ce
i I'lumhtne
❑"fatal Project Cost' I Item 6) x mutiptcr ll s
5 I -_
'. Other Fees: S
J \:rchamcal (fll':\C)) S I Lot
- - - - -
ile
wm FI e S —� f�,ralAll Fee, $> ur
-11
ck N+ l'heck Am•�un( ( '.t.h \tit.vtiu f ulal Prnjcct Cost Che
I > �d --- -- -- ---
-X06 . 0 Rod in Full ❑ (hn,t.u,Jtn�• Ral.t nsr 1)ue
r -- SECTION 5: l'ONSI'RUC hION
SERN'I('F:S
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a,l Licensed ('matrucliun Super\isur (CSI.1 IIT — ,
I,1"n.: \nlnh:r L,I,II. I:,,n lt.n:
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Litt
�anre .a t-sl. IhJJeI
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_ Ke,In.I:J I.\' I .rintl, I),,:iliny_ _.—__----__l
I:I,ph,me D Ki a solid 1 y_ hJ .n i l I3
Jtu U.�lnn _.
r ..? Registered Ilurne Impru.rment Contractor (Illl 1
IIIC('uuq,ant Nalnc or IIIC Rc-u(rant Nanlc.
WJress I?,ptrauon U,ae -
-_ hclepltune
� lr�.nat nlC
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SECTION 6• WORKERS' COMPENSATION INSURANCE AF'FID I,IT (NI.G.L. c. 152. 4 2506)1
Workers Compensation Insurance alhdavl( must br urmpk(id and whnn tied w Ith tiro apphcat�on. I :ulurr to plr .
this affidavit will result in the denial of the Issuance of the building permit.
❑ No _... ._. ❑
Si "
gned Affidavit Attached? Yes _....._ -
SECTION 7a:-0WNER AUTHORIZATION TO BE COMPLETED WHEN
OWNER'S AGENT OR CONTRACTOR APPLIES FOR BUILDING PERMIT
as Owner of(he >uhlac(.property,hereby
to ait tat niyh�lr;if, Ir :III matter+
audit tnze _—_ ------ ----__-.._—__.-
;a!::u\e to ,.tvrk authorized by this building permit .Ippbcation. ._
Date
SI¢nature of Owner
SECTION 7b: OWNER t OR :\UTHORIZED AGENT DECLARATION
I. D^ !� J . /d �(,`. , as Owner ur Authorlted .\gent hcrchy Jecl:tie ..
that th�—he stattemennts and intormatiun on the toregutne application arc (rue and accurate, to the best ,,t my kni,\slcJee and
behalF.� �-6�, —
Print at J 8 ----
Date
til�na(ur of Owner or Authorized Agent -
151'med wider The auts and penalticsol rof u 1 VOTES: .
I. :\n Owner who obtains a budding permit to Ju his/her own work. or an owner who hires an unre�l,teicd c„n(ractr'
I not registered In the Home Impru.ement Contractor I HIC4 Program 1. wdl notton hate access r, th`_Itn hndu n
program or guaranty fund under NI.G.L. c. 1"i'A. tither important Inh egulaln nit the HI(' Pro-
Consuuc(um Superttsor Licensing WSl.) can be found In 730 CMR Kegulaunns I IUR6 and 110 R5. rr,pet tvteh
When substantial work is planned, pn,tlde the Inturmanon helpcluding garage, Ilnbhed IFa�elnCll l/.title\, decks or por;hr
fatal tloors area(Sq. Ft Hahtt,Ible roam count
(irons Ilvm- .u'ea I Sq. he N -
umber of dronlns
Nmtther rI oreplaces Number of Ital l'h.nh, _-
-
Nonthecofh.ohronnts __—_—_ Nulnher A pol,hc, -
I\ t ll,en
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