58 BEAVER ST - BPA-13-897 ROOF y t
The Commonwealth of Massachusetts CITYOF
Board of Building Regulations and Standards SAL Nt
Massachusetts State Building Code, 780 CNIR dMor� Ravised hlr 20/1
Building Permit Application To Construct, Repair, Renovate Or Demolish a
One-or Tivo-Family Divelling
This Section For'Official Use Ohl
Building Permit Number. D5t led
Building --------------
Official(Print Nana lure Date
SECTION l:SITE INFORMATION
Ll Property Address: 1.2 Assessors Map& Parcel Numbers
�, P,64 V". SzUom T
1.l a Is this an accepted street?yes t� no Map Number Parcel Number
1.3 Zoning Information: 1.4 Property Dimensions:
Zoning District Proposed Use Lot Area(sq ft)• Frontage(ft)
1.5 Building Setbacks(ft)
Front Yard Side Yards Rear Yard
Required Provided Required Provided Required Provided
1.6 Water Supply: (M.O.L c.411,§5 )) 1.7 Flood Zone Information: 1.8 Sewage Disposal System:
Public❑ Private❑ Zone: _ Outside Flood Zone? Municipal❑ On site disposal system ❑
Check if yes❑
SECTION!:. PROPERTYOWNERSHIPL
2.1 Ownert of Record:
Name(Print) City,State,ZIP State,
QeAVEie :`C
No.and Street Telephone Email Address
SECTION 3: DESCRIPTION OF PROPOSED WORK'(check a that apply)
New Construction Cl Existing Building❑ Owner-Occupied ❑ 1Repairs(s) WJ .ALIteration(s) ❑ Addition ❑
Demolition ❑ Accessory Bldg. ❑ 1 Number of Units_ I Other ❑ Specify:
Brief Description of Proposed Work': G
SECTION 4: ESTli LkTED CONSTRUCTION COSTS
[rem Estimated Costs: Official Use Only
Labor and Materials
1. Building $ I. Building Permit Fee.S.' indicate how fee is determined:
Standard..Cityrrown Application Fee
2. Electrical $
❑'total Project Cost (Item.6)x multiplier x
3. Plumbing > 2. Other Fces: S ✓lJ
k M-chanical (IIVAQ $ List: J
i, Mechanical (Piro lbtal All Fees: $
Siit ,ression) _ -
4—o Clteck No. Cheek Amount Quh Amoimr.
n I'ntal Ih njcct Cult $ ��p-D �� ❑ Paid in Full ❑Outstanding Hid.ince Into:
Clau - </0 - d�
r g
SECTION 5: CO;Ns'TRUCTION SERVICES
5.1 Construction Supervisor License CSL
OS MQ License Number C.spirtt'un Datc
PA �.e�t^a m _ —Name of CSL I[older
/� List CSL Type(sae below) �
Pno tg0X / I I Type Description
No. and Street
U Unrestricted(Buildings s u el ing cu. It.
A �� u R Restricted L4e?Family Dwelling
City/rown,State,ZIP �I Masonry
RC Roofing Covering
WS windowand Siding
DS600l�S 2F3rf SF Solid Fuel Burning Appliances
g' 0-/0�� VAeAit Zpp Alie I Insulation
Tde hone hmail address D Demolition
5.2 Resistered Hot a Improvement Contractor.(II1C) 3,faa� �p /
$r;ta z> �A iMrM1G SER(�i�5
Qt Ue �7S .00D - II[C Registruion Number Expiration Dale
I IIC Company Name or 111C Registrant Name (�/���C'��^7
C5 leak / >/
No.and Street Email address
�g '19�
City/Town,State, ZIPTelephone
SECTION 6: WORKERS' COMPENSATION INSURANCE AFFIDAVIT(M.G.L.c. 152. 1 25C(6))
Workers Compensation Insurance affidavit mus be completed and submitted with this application. Failure to provide
this affidavit will result in the denial of the uance of the building permit.
Signed Affidavit Attached? Yes .......... ❑ No...........❑
SECTION 7a: OWNER AUTHORIZATION TO BE COMPLETED WHEN
OWNER'S AGENT OR CONTRACTOR APPLIES FOR BUILDING PERMIT
f, as Owner of the subject property,hereby authorize PiQi.� ew t �Cn�D
to act on my behalf, in all matters relative to work authorized by this building permit application.
O At G/D �/ i Z C/4 r'^J O
P n weer s Nam ectrom mm Da rF
SECTION 7b: OWNEW OR AUTHORIZED AGENT DECLARATION
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 true and accurate to the best of my knowledge and understanding.
Print O\oner's or Authurited nt's Name(Electr tc . ue ate
NOTES:
1. :\n Owner who obtains a building per it 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 find under D.G.L. c. 142A. Other important information on the HIC Program can be found at
\\W\V ❑1:143.^_IIY�JC:t Information on the Construction Supervisor License can be found at«ww.m:uieuv.'dL
2. When substantial work is planned,provide the information below:
Total floor area(sy. RJ _(including garage, finished basetnent/attics, decks or porch)
fro;; livin,area(iy. Flabitable room count
Number of tireplacci. _- -- Number of bedrooms -
--
Numberofbadhr,\onis Numberofhalbbaths _--_----- —_
I\'pc of heating --___--
- --
I\ Open
I I',atal I'r Tit ti, u.ue oota, Y a" m.t.' he snb;tihrttd f,u_'r0t.il I'rnjeCl lb:t"
I I l' _ _ _