2 BEDFORD ST - BPA-2009-34 POOL p _ The Commonwealth of Massachusetts
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...: ..'1t Boa id UI BUddlllg Regulations U11S sill �Idlldal"dS I
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' Massachusetts State Building Code. 780 C•MR, 7"' edition SI'.
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Building Permit Application To C'onsuuct, Repair. Reno%ate Or Demolish a Rei is,d houtw i
(ble- Or Tiro-Family Dtielling
This Section For �se Only
Building Permit Numb Da a pp ied: '
Sinature: / ---- —
Building CUIilmbS1011C1'/ lu, rector tit Buildings Dale
-- i
-- SECTION 1: SITE INFORMATION
1.1 Property Address: 1.2 Assessors Map & Parcel Numbers
I.la is this an uccepled street' yes_ _ nu Map Number Parcel \'umhrr
I t Znnine, luforri aldrinc I IA Property Dimensions:
I _ _
._c^ning D:;trl_t P:o,)o,ed Use '`oi A _u;sy Iti front.iry
LS Bai?ding Setbacks (ft) _—
!=rum Ymd -_— I Side Yards Rear Yard
Required _ Provided _ Required Provided Reyuoed PrudWcd
1.6 N'ster Supply: (M,G.L c 10. §51) 1.7 Flood Zone Information: 1.8 Sewage Disposal System:
Zone: Outside Flood Zone''
Public❑ Private❑ — Municipal ❑ On site disposal system El
Check it yesO
SECTION 2: PROPERTY OWNERSHIP' _
2.1 Owner'of�,�.rd: tJ-i l r
fYYa ria_ 55 _ "a Pad Y�Q 1em
Name(Prim) Address for Service:
Signature Telephone
SECTION 3: DESCRIPTION OF PROPOSED WORK (check all that apply)
New C:mstruction ❑ Existing Building ❑ Owner-Occupied ❑ Repairs(s) ❑�Alteration(a) ❑ Addition ❑
I—Demolition ❑ Accessory Bldg. 0 Norm her of Units— Other ❑ Specify
I3riei I e- (,don of Propos d 'Or k'.
SECTION 4: ESTIMATED CONSTRUCTION COSTS
Item Estimated Costs: Official Use Only
(Labor and Materials) _
I. Building $ I. Building Permit Fee: $ - Indicate how fee is determined:
❑ Standard Cityfl-own Application Fee
2. Electrical $ ❑Total Project Costa (Item 6) x multiplier x
i
i. Plumbing $ 2. Other Fees: S
4. Mechanical (HVAC) S List:
5. Mechanical (Fire S -
Total All Fats: $
Sui MS.Sion) :
Check No. Check Amount Cash Amount:___
b, Total Project Cost: $ d o O O 0 Paid in Full 0 Outstanding Balance Due:
SECTION 5: CONSTRUCTION SERVICES
5.1 Licensed Construction Supervisor iCSL)
License Nunther FNpilallon Dale
Name tit CSL- Ilulder LiSt CSI_Type (se•below)
AJdrces Type DeSCI'I)lion
L Unrestncled w 1 to 35.000 Cu. Fr l
R Restricted I&'_ Family Dss Paling —�
Signature .S7 \tasunry Unlv
— RC Residential R...Nine Curerimt
Telepinute \\'S RCII&Il(ial \\'mdIM ,md Sllllltl'.
SF Remdeuli:d Sohd Fuel BWlimg \ t Chance III>l.11lalli-ll
D ReNiJenlial DanluliWnt
5.2 Registered Home Improvement Contractor (HIC)
HIC Contpwt)' Name or HIC Registrant Name Registrawrt Nw^her i
Address --
Expiration Date
i
lgt, TUU UOC _
SECTION 6: WORKERS' COMPENSATION INSURANCE AFFiDA vi T Oy;.G-.L.c. 152. 9 25C(6))
Workers Compensation Insurance affidavit must be completed and so bin itted with this appl icat.o n. Failure to pray ide
this affidavit will result in the denial of the Issuance of the building permit_
Signed Affidavit .Attached? Yes ..... ❑ No ... ...... ❑
Srf C i[ON 7a: OWNER AUTHORIZATION TO BE COMPLETED WETN
OW'NER'i:_GENT OR CONTRACTOR APPLIES FOR BUILDING PERMIT
I I
1 -- __ _ ,_ as Owner of the subject property hereby
authorize to act on my behalf, in all matters
relative to work a.lthorized by this building per, application. Da e
v
d0
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ISEC'I7ON 7b_ OWNER' OR AUTHORIZED AGENT DECLARATION
as Owner or Authorized Agent hereby declare
(hat the statements and information on the foregoing application are true and accurate, to the best of my knowledge and
Signature of Ow or Authorized Agent Date
(Signed under tat ains and eenalties of perjury)
NOTES:
1. An Owner who obtains a building permit to do his/her own work, or an owner who hires an unregistered amtnactor
I (not registered in the Home Improvement Contractor(HIC) Program), will Prot have access to the arbitration
fF program or guaranty fund under M.G.L. c. 1-12A. Other important information on the HIC Program and
Construction Supervisor Licensing (CSL)can be fiwnd in 780 CMR Regulations 1 IO.R6 and 110.R5, respectively.
'. When substantial work i:: planned, provide the inhxmanon below:
Total flours area(Sq. Ft.l _ (including garage, finished baaemendamcs, decks or porch)
Gross living area (Sq. Ft.) Habitable room count_ _ -
Number of fireplaces Number of bedrooms
Number of bathrooms Number of half/bulhN
Tvpe of heating system Number of decks/ porches
"Type of coming system Enclosed Open
3. "Total Project Square Footage" may be substituted for "Total Project Cost"
MORTGAGE INSPECTION
BAY -STATE SURVEYING SERVICE INC.
234 CABOT ST., BEVERLY, MA.
LOCATION SAL i-l\ rnA5< . NOTES
•---- - i -•-•--. a. ..
" ZZI 6� • This is a Mortgage inspection survey and not
SCALE ; I = 3C FT. DATE --(�-�-•- ---- - - ----- --•---
� , an instrument survey, therefore this plot plan is for
REFERENCE _ _y�Z mortgage inspection purposes only.
• This survey is based on survey marks of
.. . .... .. .. . .. .. .. .... ... . ... .. .... .... others.
To _ _�/7S7-4f; J_ __ i1V!!v�?S__cQi4N �C•__._ s Bushes,shrubs, fences and tree lines do
I hereby certify that I have examined the premises and that the not necessarily indicate property lines.
building (s) shown on this plan are located on the ground as
• The building(s) are not located in the spacial
shown and that they conformed to the zoning setbacks of the flood hazard zone, as defined by H.U.D.
C T _ _ FS �LEM when constructed.
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