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19 BOARDMAN ST - BPA-14-122 RENOVATE 2 UNITS IN/OUT
G�� � l��r 1 ��v �- I ��.� �,� , a �5 �� � "_ 'y� ,.� Tha Cuimnonwcaldt of�(assacliusetts �� ^ } �oard oF BuilJing Regulations and StanJards �l'�Y UF ��� �bfussachusetts State Building Code, 7S0 C�fR y���E�'� RaviseJ binr 2U!! Duifding Parmit Application To Cunstnict, Repair, Renovate Or Demolish a ;• One-or Tivv-Family D�velling Chie SactionFocOfficial UseOnf . �. • Building I'ermit Number: � ate Applied:, �. • : ,.._��' � , -���, ;;,. �; 13 Bwlding Officiat(Print Nnine) , ,� Signature: Dnta'. SECT[OiY I:S[TE74VF0[LYG►TCON L l Propert AdJrear. L2 Aeaeaaor�btap�Parcel Numben /�'i �a.42I�177f,�hi � l.l a [s this an acce tad street?yea nu bfap Num6er Parcal Number l.J Zuning[nfo�mntlan: l.4 Property Dlmenalone: Zoning District Proposed Use Lat Area(sq R) Frontsge(ft) 1.3 Ouflding Setbacla(ft) Frant Yard Side Yud� Reae Yud Required Provided Requ(red Provided Required Provtded ' l.6 Water Supply;(M.Q.L a 40,§J4) !,7 Flood Zont Cnformatlont 1.9 Sewaga D�poaal Sy�tems Publ(c� Pr(vate O' Zane: _ Ou�ida Flaad 2ane9 N����� ��n�ita dl� oaai �tem ❑ Check if e�C P P 9Y • ` SE�CTIONZ; PROPEATI!'OW�4ERSfiIP!' ': : 2.1..:Qwner�of Record: }�f'z15'�- . C'oUT�'/�S �l�s S'!/�2I_y l�i�� ' Name(Print) 3Z J �`S�X. S� c�ry,Statq Z!P C o rn<°qst. ��t- �7�- i27-4'/5�7 �SCOuQ/�S � No,and Street . Teleohane Fm�ci edd..e. SECTION J: DESCRIPTION OF PROPOSED]VORK�'(check all that apply) `++ New C6nstcuction❑ Eristing Building Owner•Occupied Q Rapain(�) � ,4lteration(�) Addition ❑ Damalitiun O Accenory Bldg. O Num6e�ofUnib 2 Other ❑ Specity; E3cief Deuription uf Proposed Wark : ' yy� • �� - �i c�I/� 4�/.LS�dLu S� iL�)it/ �t rsrs� �iS'N/ .�.15'A��.� � > SECT[Oi�F J: EST(lL4TED CONSTRUCTIOiY COST3� frem Est�matzd Custs: p(Rctal U!e On1 L�6orand �fntcrials Y' . I. 8uil�ing � I. Building Permit Fes:S ` Cndicita hatv fee is dctermined: �. f:lccuic:il g QSl.�ndard.CitylCo�vrtApplicntion Fae l. plumbing �. ❑'Cut�t Piojcct Cost�(Item 6),e multiplidr � O �, t7cher Ftes: .5 t .\la<tr,ini�.il (IIV.\�) i � List: t. .\f,;�h.�nir.tl (Fir: - i�iCCrc;si�m)------ � — -- - l'otal :\II Pces� i i „ fnr:ill'rnjcet ( '���t S �� � �'IieckNo. _Chcck�lmunnt: .---('.ish :\nwiint --- i d I I� I'ii�l in ('iill O Unt;t:ui�lim� li:il:u�ca Ihi�:: - - t � c --- srcrto�v s: c��vs�r�iucrwv sF:iivicF:s 5,1 Constn�clion Supervisur License(CSL) -- __ 3 /� � 3 Licenat Numbet �xpiratiun Uate � C - O� 2 � Z -- ,I:une uFCSL I laldcr List CSL I'ypz(s�z balwv) � � Y ���� fZ/_1✓ — p a Descriptiun Vu. :u�d S'Ireat � Unrcxtrictcd Duildin �u tu JS,UUO cu. tt. � /� '�,T��\� �f�s — RestricteJ 13e?P�nnil Dw�lliu e / i�— Ciry/fu�vn,S�att, ZlP ��l \I;uonr 2C Ruatin CJ�Cflfl ��'���Z �, ���� — IVS Winduw �md Sidin SF SuliJ Fu¢l 8uming elppliancae �.. sZ����Y7 � �„�������� Email uddrc�e U Ummolitiun l'cla hwm /C/ i.E RegbhredHomeimprovementContro tor(H[C) � j 2/ � 1-�"sT-v ,�vUL��� ���£Y * �L/L��v HICRagit�mtionNumber xpir; wnUate i I IC Campany Nama ur f l!C Rcgistrni t Nmne �'7 7 S'�Sf� `S� Email addres� Na.zf s«�e�i�'LLy �'f�/�. Ci /Tuwn State ZIP Tale hane SECTIOY 6: NORKERS'CO�IPEN9A'('[ON INSU[L\MCE AFFlDAVIT(h1.G.L.c. 152. 9 25C(6)) Workera Compensation Insurance afftdavit must ba compteted and submitted with this application, Failuro to provide thie affidavit will result in the denial of the Issuance of the building'permiG SiynedAFtidavitAttached4 Ye�.......••• No...........0 SECTION 70: 01VNER AUTHORIZATION TO DE COdIPLETED WHEN OW VER'9 AGENT OEt CONTZL►CTOR APPLIES FOR BU1LDtYG PERhIIT f, as Ownec of the subjact proparry,hereby authariza to sct on my behalf, in ull mntters relative to work authorized 6y this building pnrmit applicatian. Daro Print Uwnar'f �mna(Ekctranic Signaturo) SF.CT(OY 7h: UW VER� OR AUTF[OAfZEU:\GEN'C DECL:\R:\TIOY Ely antaring my n�ma belaw, f hereby attmt under the p�ina and penultia�of perjury th�t all uf tha infurmntiun �ontaineJ in diij applieatinn is tcuo,ind accurat a best afmy knawledge and undentandi����� ,��C�Y���1��.9� -- D,�t�a— I'rint U��ner't u�WdwritcJ:\gcnt't N,una(L'1«truui�Siyuatua) ,YO'TES: I. :\n U�vna<<vhu obtains a buil�ing permit N du hivhcr uwn wurk,ur;�n uwnar who hirei an wvegistered cuntractur (nut registtro� in th� F{ouw Improvamant Contracror(NIC) Proyram),��ill nu h�va acc�se ro tha:�cbitr:itiun progr:un or�u;u�nty IimJ und�r�L(i.L.c. !i?,\. Uther imporCmt inFunn:�tiun un�ha H[C Program c;in bt fuund at ,�,��v nru+.�cuv%ora Inturm;itian un tha C;unshuction Suparvi�or I.iccns�c�n ba found:u«�v�v �n:�a...��_ �,��_��L} � 1b'han sub;tiutial �vurk ia pL�nncJ.provi,lo ih� inform:uiun balu"�1 t tiniiliaJ b:ismnenV.utics,�Icc.l•s ur purch) fur.il Nuor.ve:�(;��. 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