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3 BECKFORD ST - BP-2010-222 WINDOWS The Commonwealth of Massachusetts Board of Building Regulations and Standards FRevise OR Massachusetts State Building Code,780 CMR, 7`1' edition USE. BuildingPermit Application To Construct,Repair,Renovate Or Demolish ad January ` One-or.Two-Family Dwelling 1, 2008 This Section For OfScial Use Only. . Building P ermit Number: Date Applied: Signature: a✓ Building Commissioner/In orofBuildings Date ••• SECTION 1:SITE INFORMATION 1.1 tplroper>tp(�ddraess: I 1.2 Assessors Map 8-Parcel Numbers ,'�' 112C11.lZWG ST __ -a.\ ll� O -1 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.8) Frontage(R) 1.5 Building Setbacks (ft) Front Yard - Side Yards Rear Ward 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?. Check if yes❑ Municipal❑ On site disposal system ❑ SECTION 2: PROPERTY OWNERSHIP' 2.1 Owner'Qf Record: Name(Print) Address for Service: - Signature Telephone SECTION 3:DESCRIPTION OF PROPOSED WORK2S(check all that apply)' io:t ❑ E is n�urldu�.❑ ?^ -�'^ pied ❑ Re.p3 s(s:% A t rn(s) A 'd''cn [2 Demcilhion ❑ .Accessory Blda.❑ Number of Units Other ❑ Spceiry:__ Grief Description of Proposed Wodc': t S O k1 t SECTION 4:ESTIMATED CONSTRUCTION COSTS Item Estimated Costs: Official Use Only (Labor and Materials) I.Building $ 3 1. Building Permit Fee:$ Indicate how fee is determined: 2.Electrical $ d ❑Standard City/Town Application Fee ❑Total Project Costa (Item 6)x multiplier x 3.Plumbing $ 02. Other Fees: $ 4,Mechanical (HVAC) $ List 5.Mechanical (Fire $ Su ression) b Total All Fees:$ 6.Total Project Cost: $ 5 Check No. Check Amount: Cash Amount: , 3 �1 0 Paid in Full 0 Outstanding Balance Due: SECTION5: CONSTRUCTI;ONSERV ES 5.1Licensed Construction Supervisor(CSL) q5 U -7 (((�� " "r tC-tn �cyi t License Number Expiration Date Nlamee rof CSL-Holder I LisrCSL Type(see below) 1 l ©�iS S�- tNUt4 t�6W 8153�- Address T e ".: Description _/'y3� U Unrestncted(u to 35,000 Cu.Ft �,�� Signature C9,"'y R Restricted 1&2 Family Dwelling Masonry� Tv1 o Only U nn'c1 C7 iC1� RC Residential Roofing Covering - Telephone. WS- Residential Window and Siding' - SF Residential Solid Fuel Buming Appliance Installation - D Residential Demolition �2 Registere Homy Improvement S,n, actor(Inc) \iAewec( � 1 i�ncAr:/S IJ IJ-enn`StA4 IC Coil mpany Name or HIC Re istrant�l a Registration Number I O 4 0-kMdress s S rJg t� va-� tw tMA d l s3 a Expiration Date Signature Telephone SECTION 6:W0Pj RS' 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...........❑ SECTION 7a;:OWNER WTHO=ATION T.O,BE COIVIPLETE)�,3?>IIE'N:." OWNER'S AGENTORiCONTRACTOR APPLIES FORBIJILDIlVG PERIVIST" I, 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. . Signature of Owner - Date - -SECTION 9b. OWNER' ORAUTHORIZEDA ENCD JARATSON rt �tri' L]� i(�t S"cam— aeovvnet'orAt. itizedAt tierthy -,clge rt that the 5tatenietils and information on the f_seeeiug'an licatioti'are.frue and accivale, to die best of niy l-how be aiid b Half. i rt � n �� n/L? Su� � Signature of Owner or on ed A e Date (Si ed under the pains and penaTties of a 'u - NOTES: 1. An Owner who obtains a building permit to do his/her own work,or an owner who lures an unregistered contractor (not registered in the Home Improvement Contractor CHIC)Program);"ill 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 790`CMR Regulations 110.R6 and 110.R5,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 ofhalflbaths Type of heating system Number of decks/porches " Type of cooling system Enclosed Open 3. "Total Project Square Footage" maybe substituted for"Total Project Cost'