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27 BOARDMAN ST - BPA-10-473 REMODEL KITCHEN t 1 /I" The Commonwealth of Massachusetts Town of Board of Building Regulations and Standards -a.—Ao Massachuscits State Building Code. 780 ChIR, 7"edition BwN,ng Dept Building Permit Application To Construct. Repair. Renovate Or Demolish a One- of As too-Famth'Din ellind This Section For Official Use Onl Building Permit Numbe Date Applied: SignNre: Build, Commissioner/Iq is Building Dow S CTION I:SITE INFORMATION 1.1 Pro pert Address: 1.2 Assess*re Map• listed Numbers M Number Parcel Nutnber I.1 a ls this an acc tedee slrl°Yes no 'p 1../ Zoning Information: La Ares 1.1 Property Dimensions: Frontage I 2omne Dwnet Proposed UseIsq R) M 1.9 Building Setbscks(R) Front Yard Side Yards Rer Yard Required Provided Required Provided Required Provided 1.6 Water Supply:(M.G.L c.a0,)se) 1.7 Flood Zoe@ Infu msdon: 1.8 Steerage Disposal SYstem: Zorw: _ Outside Flood Zorw? Municipal O On site disposal system O Public O Private O Cheek if SECTION 2: PROPERTY OWNERSHIP' 1 Owner'ofR cord: a ©�rG+!"i/Ati! Sf, �04-7 t ) urns Nam i Addict far Service: ynstwe Telephone SECTION): DESCRIPTION OF PROPOSED WORK'(check sB thst apply) New Construction O Eitisting Building O Owner-Occupied O Repairs(s) O Alteration(s) O Addition O Demolition O Accessory BIdB.O Number of Unit_ Other O Speci&: Brief Description of Proposed Work v ra�s7_ ens' reo/a ; ,� a SECTION 4:ESTIMATED CONSTRUCTION COSTS Estimated Cost: OOlcal Use Otdy Item #I ahor and Materials I. Building I. Building Permit Fee: f Indicate how fee if determined: O Standard CirytTown Application Fee 2 Electrical f O Total Project Cosh(Item 6)s multiplies_ a ) Plumbing f 2. Other Fees: f a Mechantcal IHVAC) f List: t Mechanical (Fire S Total All Fees. f Su ession Check No. __Check Amount: Cash Amount: / 6 Total Project Cost f a p 0 Pad in Full 0 Oubtandmt; Balance Due SECTION S: CONSTRUCTION SERVICES 9.1 Licensed Construction Supervisor ICSL) M • Liccn.e Number Espuauon Date N.yer,t(cSl•JtptJat Li.t CSL Type txe heluwr AJkrse Type I Description U I Unrestricted tug tolS.000Cm A R Restricted 1d2 FamilyDwrllin SraMlwf St I Masonry only RC Residential Rao6n Covering Tekphone W S Residential Window and Siding SF Residential Solid Fuel Bummil Appliance Installation D 1 Residential Demolition 5.2 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.e. ISL/ 2SC(6)) Workats 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 AMdevit AnachatV Yes..........O No...........O SECTION 7s:OWNER AUTHORIZATION TO BE COMPLETED WHEN OWNER'S AGENT OR CONTRACTOR APPLIES FOR BUILDING PERMIT 1. . as Owner of the subject property he aulhorize to six on my behalf,in all matters relative to work authorized by this building permit application. Si or Owner Dew - SECTION 7b:OWNEW OR AUTHORIZED AGENT DECLARATION v I. �•/�✓ "1 f M- Burrs,as Owner or Authorized Agent hereby declare that the statemea and informalon on the for goi S application are true and accurate, to the best of my knowledge and Ka If. n Print Si stun of or Awhorized Agent Dew A under t ins and allies of NOTES: 1. An Owner who obtains a building permit to do his/her own work,or an owner who hires an unregistered contractor (nor registered in the Home Improvement Contractor 1 HIC)Program).will Sg have access to the arbitration program or guaranty tied under M.G.L. c. I42A. Other important information on the HIC Program and Construction Supervisor Licensing(CSL)can be found in 780 CMR Regulations 110 R6 and 110 RS,respectively. 2. When subsranlial work is planned,provide the information below• Total Doss am ISq. Ft.) (including garage, finished basemenVattics.decks or porch) Gross living area I Sq. Ff.) Habitable room count Number of fireplaces Vumberofbedrooms Number of bathrooms Number o!half baths Type of heating system Number olJtcks/porches Type o(cooling syuern Enclo.rd Open I 'Tatal Project Syuare Footage"may he.uh.nmteJ for-'Total Projcci Coa"