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2 BECKFORD ST - BPA-2008-816 RENOVATE & ELECT PERMITS LosxunanwaalUl a /r(ewat�ru�sdLi Official Use Only c.. �s�artou+xt a`.1iri Jcraiwes �emiit i`lo• BOARD OF FIRE PREVENTION REGULATIONS Occupancy aaaMb!5 Fee Checked '73 kmve 6imnx. APPLICATION FOR PERMIT TO PERFORM ELECTRICAL WORK All work to be performed in,accordance with the Masseebuseus Electrical Code(&MC).$27 CMR 12.0 - (PLA.4SEPxjY W IJVK OR MEALL XFOPM4710.19 Date:. City or Town of: SILL EM 710 the Inspector of Wires: By this application the undersigned gives notice h3 or her n lion to perform the electrical work described below. Location(Street& Numbe LZ `C.CI.C.. r f Owner or Tenant Telephone No. Owner's Address ?- `ram.C-4- Is this permit in conjunction with a building permit? 'Yes 9 No © (Check Appropriate Sox) Purpose of Building C.o Utility Authorization No, Existing Sorrier Amps t Volts Overhead 0 Undlprd 0 No.ormeters New Service _ Amps 1 Vohs Overivad❑ Undgrd No.or Meters Number of Feeders and Ampacity Location and Nature of Proposed Electrical Works jd ~i ram_ tire✓ 7� Compkilon ofthe foallawl. .wNe m be waiwd b the t q g €dor Wirer. Na.of Recessed Luminaires No.of Ca-Suusp.(Paddle)Foos o.o ota Transformers KVA No.of Luminaire Outlets No.of Hot Tubs Generators KVA No.of Luminaires Saimmlag Poal : d e 0 Ed. satte Un 1ssney ng No.of Receptacle Outlets Na,of Oil ilur sers FIRR ALARMS No.of Zones of Veftetioa and No.otSwitches No.of Gas,Burners faltieft Mvtm Na otliaagrs Na of Air Coed Total TO" No.of Alerting Devices III No.of Waste Disposers To4mis um r ons Detection/Ale Devltxs onc No,of n Dishwashers SpaerJAa Heating KW Local© Cyyoutaciioa El {)rlt� No of Dryers Ileat'sng Appliances KZV Security systems: Der ca orEttulvaleat o Heaters KW of WaterK or Ballasts No.of Data Wiring: _..___.. No.01Devicesorgaulvaicnt No.Hydromassage Bathtubs Na.of Motors Total III! °lecom Na o®Dtvt#x ar uiva eat OTHER: _ Attach additional derail ildesord or as rvqutred by the larxetar ofWir€s. Estimated Value of Electrical Work: (Whets required by municipal policy.) Work to Start: inspections to he requested in accordant with MEC Rule 14,and upon completion, INSURANCE COVERAGE: Unless waived by the owner,no permit for the performaatce of electrical work may issue unless The licensee provides proof of liability insurance including"cwmpieted operation"coverage or its substantial equivalent. The undersigned certifies that such coverage is in force,and has exhibited proctor saute to the permit issuing offm CHECK ONE, INSURANCE ibND [] OTHER 0 (Specify:) I c erdfp,under the trains andpenadiles ofteriury,that the Infortnatdan on this applicatio»is true and complete. FIRMNAME: L-- LtC.NO.: Licensee: l (,I t ago Signanir LIC.NO. t`dfaplacrrble viral ..egv`qt tDre tkerrre nam4€r laT .} Sus.Tel Address: 4T (,Lairs-- d,31 - lea l �oC`tloo Mt Tel No �ia1,7�9z-/n<SS *Per M.G.L.c. 147,s.57�61.security work requires Deportment of public Safety'"S"License; Lic.No OWNER'S INSURANCE WAIVER: 1 am aware that the Licensee does not hove the liability hummuce coverage,normally requited by taw. By my signature below.I hereby waive this requirement. I am the(check one)f7l owner 0 owner's agent. Owner/Agent ' R XT FEE,$ Signature Telephone No. r The Commonwealth of Massachusetts Board of Building Regulations and Standards FOR MUNICIPALITY State Building Code, 780 CMR, 71h edition USE Building Permit Application To Construct, Repair, Renovate Or Demolish a Revised Atnuar. One- or Two-Family Dwelling 1, 'rxis This Section For Official Use Only Building Permit Nu r. ryI Date Applied: Signature: Z 2� O Building Commissioner/ Inspector of Buildings Date SECTION 1: SITE INFORMATION- ZptopCrl dp drgss: �� 1.2 Assessors Map & Parcel Numbers 1.1a 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: Zone: _ Outside Flood Zone? Public Private❑ Check ifes❑ Municipal On site disposal system ❑ SECTION 2: PROPERTY OWNERSHIP[ 2.1 wnertof a ord: 2 � � g� r t l. vrL S Address for Service- s elephone SECTION 3: DESCRIPTION OF PROPOSED WORK*(check all that apply) New Construction ❑ Existing Building Gt Owner-Occupied iK I Repairs(s) ❑ 1 Alteration(s) Addition ❑ Demolition 0, Accessory Bld . ❑ Number of Units_ I Other ❑ Specify: Brief Descriptio`n of Proposed Work 2: 4- rA- L SECTION 4: ESTIMATED CONSTRUCTION COSTS Estimated Costs: Official Use Only Item (Labor and Materials) fa 1. Building Permit Fee: $ Indicate how fee is determined: I. Building $ pp-o ❑Standard City/Town Application Fee 2. Electrical $ o' ❑Total Project Cost(Item 6) x multiplier x 3. Plumbing $ 1 L9 2. Other Fees: $ 4. Mechanical (HVAC) $ List: 5. Mechanical (Fire $ Total All Fees: Suppression) Check No. Check Amount: Cash Amount: 6. Total Project Cost: $ 12 ( 0 O P<Paid in Full 13 Outstanding Balance Due: SECTION 5: CONSTRUCTION SERVICES 5.1 Licensed Construction Supervisor(CSL) License Number Expiration Date Name of CSL-Holder - List CSL Type(see below) T Description Address U Unrestricted(up to 35.000 Cu. Ft.) R Restricted 1&2 Family Dwelling Signature M Masonry Only RC Residential Roofing Covering O Telephone `o WS Residential Window and Siding SF Residential Solid Fuel Burning Appliance Installation D Residential Demolition5.2 Registered Home Improvement Contractor(HIC) HIC Company Name or HIC Registrant Name Registration Number Address Expiration Date Signature Telephone 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 .......... ❑ No........... 13 SECTION 7a: OWNER AUTHORIZATION TO BE COMPLETED WHEN OWNER'S AGENT OR CONTRACTOR APPLIES FOR BUILDING PERMIT I as Owner of the subject property hereby authorize to act on my behalf, in all matters l� relative to work authorized by this building permit application. O Signature of Owner Date SECTION 7b: OWNEW OR AUTHORIZED AGENT DECLARATION I, as Owner or Authorized Agent hereby declare that the statements and information on the foregoing application are true and accurate, to the best of my knowledge and behalf. Print Name Signature of Owner or Authorized Agent Date (Signed under the pains and penalties of perjury) 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 and Construction Supervisor Licensing(CSL)can be found in 780 CMR Regulations 110.116 and 110.115, respectively. 2. When substantial work is planned,provide the information below: Total floors area(Sq. Ft.) (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"may be substituted for"Total Project Cost"