8 BECKET ST - BPA-12-973 SIDING I he Cbnunomsralill Massarhusclts
Iluurd Of Iuilding Regulations and Standards C'I'I'1.OF
Massachusetts State Building Code. 7SO C NIR S.\LI{\I
'L,•• llerieeJ IGu 'U//
Building Permit Application To Construct. Repair. Renovate Or Demolish a
One.or Tivo-k'amilY Uuellinp
This Section For Oil • Use Onl
Building Permit Number: _ D tcAApppll"ieedd-:
< �,
Budding oirmal(Print N;une) Signature 1ill
3J
SECTION I:SITE INFORMATION
1.1 Properly Address:: 1.2 Assessurs blap& Parcel Number
1.1 a Is this an accepted street? es no Map Number I'urccl Number
1.3 Zoning Information: 1.4 Property Dlmenslonr.
Loring District Fnrposcd(Js¢ Lot Area(sy It) Frontage(Il)
1.5 Building Setbacks(R)
Front Yard Side Yurds Rear Yard
Required Provided Required Provided Required 1'rovidcd
1.6 Water Supply:(M.G.I.c.ao.§Sq) 1.7 Flood Zone Information: 1.8 Sewage Disposal System.
Ihrblic� Private❑ Zone: _ Outside Flood Zone? Municipal�On site disposal s vtcm ❑
Check if �esR" P po >
SECTION2: PROPERTY OWNERSHIP'
2.1 Ownerr of Recor�
�A I t yvt r a. O I eat—I O
N;un4u(PrinU (u)•,Statr,l.IP
act-l� .._Ic7 Ow•s
Nu.and Street Telephone —� hmml Address
SECTION J: DESCRIPTION OF PROPOSED WORK'(check all that apply)
New Construction❑ Existing Building Osvner•Occupied tQrf Alteration(s) Cl Addition ❑
Demolition ❑ .Accessory Bldg. ❑ Number of Units 1 Other ❑ Specily:
Brief Description of Proposed Work': <�:
SECTION 4: ESTIMATED CONSTRUCTION COSTS
hens Estimated Costs:
U.abor and.Materials) Offlclal Use Only
I. Building S I. Building Permit Fee: f Indicate how I'ee is determined:
2. Elcetrical S ❑Standard CityiTotsn Application Fee
❑Total Project Cost'(item 6)x mulliplier
J. 1'huuhing S 1 Other Fees: 'S ---- —
J. Mccl;anic.d ;II\'.\V) S List:
Su presmonl rotal .\Il Fees: S
Cheek No. ('heck Amount: C,ish \mount:
I, Total Project Cnst: S -- . .
!' t7 0 00 ❑Paid in Full 0 UwsLmJin_g._Ila._.l:mce Due:
SEC PION 5: CONSI-RUCTIONSERVICES
5.1 ('ottslructioliSul)enisor License((Si.)
r\piration Date
S1, I tolder I is CS I.
Description
"re"r,'te'
R 110,tricled 1&2 1: I'l
Cihiloml.State,/11' %lasoli
RC lRix,fin Co%crin
'n Sd
%S Window.uicl sidin
\PP ".s
SF Solid Fuel Ilurning Appliances
I huulait,
in
Talc hone fillailaut1res.4 D
"nou,1"n
.4.2 Registered Home Improvement Contractor 0110
I IIC Registration Nt Fni-tZ Eviration Mic
I 11C Compin) Name or I IIC Registrant Nanto
No.aid Street Email address
City/Town.State,ZIP Talc hone
SECTION 6:WORKERS'COMPENSATION INSURANCE AFFIDAVIT(M.G.L c. 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 .......... 0 No...........13
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
to act on my behalf,in all matters relative to work authorized by this building permit application.
Print Owner's Name(Electronic Signaturu) 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 inrormatiun
contain this application is trugand accurate to the best of my knowledge and understanding.
Print 0\\ner's or r\uthariruJ \ga 'a Name 11'.kclrunic Signature) Daly
Nons:
I. kn Owner who obtains a building permit to do his,her own work,uran owner who hires an unregistered contractor
In 07%,�
11""ho
(not registered in the Hume Improvement Contractor(HIC) Program).will!Up have access to the arbitration
c Is I
prograill or guaranty fund under M.G.L.c. 142.A. Other important information on the HIC Program can be l'ound at
�0% ".1 Information on the Construction Supervisor License can be found at
2. When substantial work is planned,provide the information below:
rota) flour area ls.q. A., - _—__.-_i including garagt, finished basement attics,decks or purclu
(irons lining area isq. fl-I ilaiiiiable rouni count
\jumber offircillaces Number of hcdrooms
%kiiiihcrot'hathroums \11111M of liall ballis
lie of healing s)steal Ntoiihcr of decks, porches
I'lielt"ed 011en
1.\11c
1'oi,il Project Stitore Foolj4o- ii;1\ he itibittmicd 11or l'olal Projed Cost-