8 BEDFORD ST - BPA-13-416 NEW KITCHEN & BATH _ 1 --- I'hc C'ununun,ccalth ul'blassarhuselts
s ' Ili,.ird al•Iuilding Regulations ;Ind 5umdards CITY DF
II ' YYY ll' "Sc Its SMIC Building Code. 730 CNIR
Building Permit pplic;llit'll To C'onsUuct. Repair. Rcnuv;lte Or Demolish a
Unc- or Tun-f iunllt Utre iu.l+
This Section For 011icial Use Only
Building Permit Number: U ro.lpplicd: _
IhulJmy gllkml IPrint N;una)
.Sfgnalu Dala
SECTION I: SITE INFORMIATIO
L I Prope - A ass r q� 1.2 Assessurs flap % Parcel Numbers
I.la Is this an acre led street? es no Nap Number Purcal Nuntbcr
1.3 Zoning InformuNont 1.4 Property Dimensions,
Loamy Disuicl I'ntpnuJ ll�_ Lut An:u(s Iq
V 1.1 BuIldlnaSelbeeks Fmnluya III►lR) I
Front Y:vd Side Yunla
Required Provided Rryuind IkuviJrd Near Yurd
Required IsroviJeJ
1.6 Water Supply.( I.c.J0, §!4) 1.7 Flood Zone Informations 1.2 Sewa`e Dlaposal System:
Niblie❑ PH%ace❑ Zone: _ OtiWide Flood Zone?
Cheek if va❑ Mwieipd❑ On site disposal s)stem ❑
SECTION 2: PROPERTY NERSHIPt
2,.an rto^ rdt
Ny lie(rm) _ 70
cily.Stata.Lp1P .
' telephone Einuil AJdrosa
SECTION is DESCRIPTION OF PROPOSED WORK (check all that apply)
New Construction❑ Existing Building❑ Owner-Occupied ❑ Repairsls) ❑ Alteratlon(s) ❑ Addition (3 Demolition ❑ accessory Bldg.❑ Nun,berof Un'ts
Brief Descri tion fPropo d Wor Other ❑ .S icily;
SECTION 4: ESTIJI.ATED CONSTRUCTION COSTS
Item Estinsnled Costs:
Il.ahurmd\Iateriats) Ofllclol Use Only
I DuilJing S e4 L Building Permit Fee: S Indicate how tee is determined:
2. Elrnrical S IA O Standard City+To,sn Application Fee
t Plumbing S �� ❑Tutal Project Cost'(lien,6).x Inultiplier
2. Other Fees; S_
J. \Ic�lianic.d ill\ 1('1 S List:
�uaessionl S total .\it Fccs: S_
Foul Projecl CuN: S �a 1.hv:k Vo, _. ___( hrcA .lnunmt: _ _. ._. .( • ,h \n iunl:
O P.iiJ in Full ❑OutsuwJing IIaLlncc Due:
Si:("I'ION S: ('ONSl'Rli("PION SERN'R FS au�q y
S,I C nst uctiunSupervisu Liceose(CSI.)
I ecu.c Ntnuhcr Isplratiau I);nc
Wwkc-s_ll
_.._. I Ivl l�L I) helm.!.V_.ldcr (� (� —��
p,. I)cxripliun
N,1. anJ. eel (I 141reslrieleJllluJJinali tolt,lllln❑1. 11.1
070 _ It Re,lricteJ Tamil D»ellin
Cigll'o»n.State./.11'--+— KC Rtwdin Cuterin
µS µ'intlnsv-Ulu".in
p.� SF Solid Fucl burning.\PPliances
I Insulwiun
D Dmuolilian
1'cle hone fmuil;IJJres �� � r2
S.2 Registered I�um� Ipt )r ryFnt Contractor(HIC) IiIC Itegiwutiun Nut»her ;s(P/r/�/�t/i�,n Dwe
1IIC'C' npill) Nall kit II CItegislt It to /X/eRrf Y ��
o
�� r! l:muil adJhss
Nu. J stna
Ci !town. State 21P P
a 7elc hION one
INSURANCE AFFIDAVIT(M.C.L C. I-2. 25C( )
SECTION 61 WORKERS'COM- EN SAT
---
Workers Compensation Insurance affidavit must be completed and submined with this application. Failure to provide
this atfdavit will result in the denial of the Issuance of the building permit.
Signed Allidavit Attached? Yes ....,....•
No...........O
SECTION 7a=OWNER AUTHORIZATION TO BE COM1IPLETED WHEN
R
OWNER'S AGENT OR CONTACTOR 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.
Data .
Print Utsncr's Nune(Electronic Sipnuturo)
SECTION 7b:OWNERI OR AUTItORIZED AGENT DECLARATION
By entering my name below. I hereby attest under the pains and penalties of perjury that all of the informatiun
contained Ili this application is true and accurate to the best of my knowledge and understanding.
�uw
I'riw q»nerbur;\uthorircJ,\pent's N;uuu Ilileannlie Sipn:durul
NO'rESt
tkin nut�egistered in the a Improing vement nenttrinit tCwur lctur IHICI Progran) oll rut shave access to III Its an thearrbitrationered uractur
rnil ion on I
pmgnntluf guuruu)I lul nfontnu un un he Construction hS»pery sor License can be found alC,program c'nsbel'bunJ at
\\-hen substantial%sofk is Pl:uuted, pratide the inl'ultinctlon bclo'f' e. IinishcJ buementattics.Jerks nr purclu
2. g p• b
Total flour area I;y. R.t . --- ilabilable town count
(Iroii lis ing area I sy. ll.l --... . .. .. \unlhcr of hedrooms -
I \unlberoI,Iireplaces .. _ --- Nunlher kit'hall'halhs
\unlhcr al hathraonls , . \umher ol'Jedi, porshes
I\Ile of heating s),tam I'nela,cd . ,1)pen
of:oohog is item
t "1 LII lfUleel ti.111;1f1' (pOla�e Ill lit he Q,h,jjt111cd tisr roml ProjM 0111