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63 BEAVER ST - BPA-14-1731 SIDING 7 — 73 1 L17, ICI re The Commonwealth of Massachusetts RECEIV 0 F Board of Building Regulations and Standards $PECj101R SEFttSALE I Massachusetts State Building Code, 780 CMR VA Vio VA 2011 Building Pert plication To Construct, Repair, Renovate Or,DMWW One- or Two-Family Dwelling This Secfton For Official Use Only iy Building Permit Nu :Datepliedi Building0fficial(PrintName) ' Signature Date. SECTION I: SITE'INFORNIATION 1.1 Pro er Address: 1.2 Assessors Map& Parcel Numbers 1.1 a Is this an accepted street?yes_ 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.G.L c.40,§54) 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 2; PROPERTY OWNERSHIP' 2. Owner of Re c d: t one S /� b.AIJ �L�LPM�.� L 0770 Name Print) City,State,ZIP 0 a�W'fi- 7'? /VV^-e— No.and Street Telephone Email Address SECTION 3: DESCRIPTION OF PROPOSED WOR14'(check all that apply) New Construction ❑ Existing Building Owner-Occupied epairs(s) Alteration(s) ❑ Addition ❑ Demolition ❑ Accessory Bldg. ❑ 1 Number of Units_ I Other ❑ Specify: Brief Descn lion of P ased NVork': a SECTION 4: ESTENLkTED CONSTRUCTION COSTS- Estimated Costs: [rein Official Use Only, Labor and Nlaterials 1. Building $ OUJ 1. Building Permit Fee:,$ Indicate how fee is determined: ❑Standard City/Town,Application Fee 2. Electrical $ - ' y . ❑'total Project Cost. (Item.b)x multiplier x 3. Plumbing S 2. Other Fees: S 4. Mechanical (HVAC) S List: ,5. Mechanical (Fire $ So ip pression) rotal:Vl Fees: .S i — — S (/ //,,U� U7— Check No. Check Amount: Cash Atrwunt T 6 ital Project Cost: � V 3, Balance Duo: I / v �xr w t�- � ► 1.©. c rat fJ Part L400 t t If, Gfkl� b kZ - 5-1 t— of 0 SC> SrCT10N 5: CONSTRUCTION SERVICES 5.1 Coiish ucliuti Superviso'r Liccuse (CSC,) /Ov` _ License Number Expiration Date Nmneft lder /t r» CA_ �1 � �,lOj List CSL Type(see below) �o and Street Type _ Description U Unrestricted Duildin s up to 35,000 cu. tt. / 1l'<•-t�-7—XJ�-(� w R RestrictedI&iFamil Dwellin Cityfron,State, ZIP` bI Masonr RC Ruotin Covcrin \VS Window and Sidin �7_ SF Solid Fuel Burning Appliances 1 '�� SZQ �e _ I Insulation I c e one Email address D Demolition ZDRegi tered Horne Improvement Contractor(HIC) � s— 0 l V U �� I C Registratt on Number JExpiration Date 11 Comp y Name or 1-IIC Registrant Name j {rr"r'l. 's—+ — No. an Stree O / 7.57� ,q,,cr7 Email address City/ own, State, ZI ( Telephone SECTION 6: WORKERS' COMPENSATION INSURANCE AFFIDAVIT (M.G.L. c. M. § 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........... ❑ SECTION 7a: OWNER AUTHORIZATION TO BE COMPLETED WHEN OWNER'S AGENT OR CONTRACTOR APPLIES FOR BUILDING P/E-"ItT 1, as Owner of the subject property,hereby authorize to ct on my behalf, in all matters relative to work authorized by this building permit application. 4�� a&1 /'0 - 31 -�� Print Owner's Name(Electronic Signature) Date 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 dcontained in this application t true and accurate to the best of my knowledge and understanding. er's or r\uthorizcd:4gent's Name(Electronic Signature) Date NOTES: I. r\n Owner who obtains a building permit to do his/her own work, or an owner who hires an unregistered contractor (not registered in the Houle Improvement Contractor(HIC) Program), will not have access to the arbitration program or guaranty fund under i`l.G.L. c. 142A. Other important information on the H[C Program can be found at www.mass.� ov oca Information on the Construction Supervisor License can be found at www.mass.jiy;41L 2. When substantial work is planned, provide the information below: Total floor area(sq. R.) —(including garage, finished basement/attics, decks or porch) Gross living area(sq. tt.i - Habitable room count Munberoffreplaces- ?lumber of bedrooms _-- --__—_-- Number of bathrooms Number of halE'battvs _ fype of hooting system - _ -_-- _--_--- Number of decks/porches FN pe of cooling sy:tent__ __--_ Enclosed ---- . _.Open _ ..total I n� uc[ti, uare Fo��tagr" nta be ,ub,tihmcd E)r''rntal I'roiect Cost" - '