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30 BOARDMAN ST - BPA-16-132 1ST FL RENOVATIONS The Commonwealth of Massachusetts I Board of Building Regulations and Standards CITY OF Massachusetts State Building Code, 780 CMR SA EM Mar Revised Mar 2011 Building Permit Application To Construct,Repair, Renovate Or Demolish a One-or Two-Family Dwelling (V This Section For Official Use Only [� Building Permit Number: Date Applied: 9 Building Official(Print Name) Signature VADate SECTION 1: SITE INFORMATION 1.1 Proper AddreSs* 1.2 Assessors Map&Parcel Numbers 3© 15oA2e M�YA/ �>� 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 ft) Frontage(11) 1.5 Building Setbacks(ft) Front Yard Side Yards Rear Yard 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: Public❑ Private❑ Zone: _ Outside Flood Zone? Municipal❑ On site disposal system ❑ Check if yes❑ SECTION 2: PROPERTY OWNERSHIP` 2, caner'of R$Sord�r /� n 45it C G`]FsA'CTO((�' Terla PC tte-(b 70 Name(Print) City,State,ZIP 30 92At !DA ✓ Sr No.and Street Telephone Email Address SECTION 3:DESCRIPTION OF PROPOSED WORK'(check all that apply) New Construction❑ Existing Building 9 Owner-Occupied ❑ 1 Repairs(s) ❑ Alteration(s) ❑ 1 Addition ❑ Demolition ❑ Accessory Bldg. ❑ Number of Units 2 Other ❑ Specify: Brief Description of Proposed WorO: J Sr rL.e nyL APT — RCLOe A'CE he I TC 146'A/_ 19 bC hT E SA 7"kR" Te, Gd yM. e 7 PQ2 C N i2CPMce- CCI C 1,ve5 SECTION 4:ESTIMATED CONSTRUCTION COSTS Estimated Costs: Item Official Use Only Labor and Materials -- 1.Building $ 4 j�zU 1. :Building Permit Fee: $ Indicate how fee is determined: 2.Electrical $ 7S� ❑ Standard City/Town Application Fee ❑Total Project Cost'(Item 6)x multiplier x 3.Plumbing $ aop 2. Other Fees: $ 4. Mechanical (HVAC) $ List: 5. Mechanical (Fire $ Suppression) Total All Fees: $ Check No. Check Amount: Cash Amount: 6. Total Project Cost: $ S7 ty ❑Paid in Full ❑Outstanding Balance Due: SECTION 5: CONSTRUCTION SERVICES 5.1 Construction Supervisor License(CSL) Cs- d!M 2Qq I Q 1 T`y.rt.N-C12_ 141gLL License Number Ex ration Date Name of CSL HHoder & 9 tRC N Pew C List CSL Type(see below) No.and Street Type Description - - Lem MA (D'Q.76 U Unrestricted(Buildings u to 35,000 cu.ft. 1 R Restricted 1&2 Family Dwelling City/Town,State,ZIP M Masonry RC Roofing Covering WS Window and Siding G t /� SF Solid Fuel Burning Appliances 7 78 7'/-7 8 �I tL®9 @ t,O VICA-5/ . u61 I Insulation Telephone Email address D Demolition 5.2 Registered Home Improvement Contractor(HIC) /Od3 46 -1'ly r: L Ex 1�n I n LL HIC Registration Number �Fa7Ep(rr�aGtrion Date HIC / ny N ReM9 Name GAS ® 9& lcaf�%f 7, Al No.and 5'Street U/n7D g r7g 14G 1 Email address 7 1 City/Town, State,ZIP Telephone SECTION 6: WORKERS' 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 .......... e No........... ❑ , SECTION 7a: OWNER AUTHORIZATION TO BE COMPLETED WHEN OWNER'S AGENT OR CONTRACTOR APPLIES FOR BUILDING PERMIT 1,as Owner of the subject property,hereby authorize F�l rtc 1410 1 JAL to a�cct on my ehalf in ell mat�tters relative to work authorized by this building permit application. K�char Saab^Q Print Owner's Name(Elec Signature) Date SECTION 7b: OWNEW OR AUTWORIZED AGENT DECLARATION By entering my name below,I hereby attest under the pains and penalties of perjury that all of the information contained in this pplication is true and accurate to the best of my knowledge and understanding. Print Owner's or Authorized Agent's Name(Electronic Signature) Date NOTES: 1. An Owner who obtains a building permit to do his/her own work,or an owner who hires an unregistered contractor (not registered in the Home Improvement Contractor(HIC)Program),will not have access to the arbitration program or guaranty fund under M.G.L.c. 142A. Other important information on the HIC Program can be found at wy .mass. ove /oca Information on the Construction Supervisor License can be found at www.mass.gou/dps 2. When substantial work is planned,provide the information below: Total floor 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 of half/baths Type of heating system Number of decks/porches Type of cooling system Enclosed Open 3. "Total Project Square Footage"may be substituted for"Total Project Cost" J BATHROOM IN DINING ROOM(BUSTING) LIVING ROOM(E)OSTING) G PROVIDE NEW WALL. MATCH EXISTING CONSTRUCTION TYPEANDFINISHES r j NEW DOOR ;� PROVIDE NEW WING WALL. OPENING- MATCH IXISTING CONSTRUCTION 7XB BY 6' TYPE AND FINISHES OI STAIR Y-0'3 6'-0'3 T-0'x NEWOPENING i k, It z. I � _ L \71 BEDROOM I(NEWI I KITCHEN(EXISTING) r BEDROOM P(IXISTING) 'I STIR00 ' v II I4 I r, 00 __-- II f{ L CONCEPTUAL LAYOUT (UNIT 1) SCALE: 4 -0" n