34 BOARDMAN ST - BPA-2009-92 REPLACE SILL ON NO. SIDE Ilie GIIIII!ion�kca l lh of \fa-N,.c I ai Ncl I,7
- Homd III Bulldme RClulallol s ind Srancl ud, \II ♦I( II' (III l
\ � \laaa:hu,rl(s Slue 11uilJine Code. 'So('MR. rJul;al
I
I HuilJim_ Prnnil :\pplie.ult,n Tu <'r,n>uua. Repair. Renrnah• ()I I)rnll:li,h a
I)nr- r:rTttrrl ;innlr !)trr/111ov
I*hu Se:nun For Official ('se (.)nl_v ----- __----- -
MulJinu Perrot N1'iiber: —. .__. Rire Applied
n.nmeN In ec1ot ::I IfulWwg, Den•
SEC'HON I: SITE INFOR\1.\PION
1.1 Properly \ddress: -- -- 1.2 \ssessors Map it Parcel .Numbers ----- -
`-�--fxoU-fc -Tz-4 H ----- - ----- ---
_. —_— —__...�� —__—_.—_ \Lr Suinhcr I'.a.el \uulhei
I I.I I, this .lil .Ir,epleJ ,heel ' ,e,.- _-__ Ito___ P
I ----- - -- -- --. -- -7
' 1.1 Zoning Information: I 1.4 Property Dimensions:
nI
`i Zf nb � Dninrt Prll(R � ! ,• I I.w irca l,tl it) --_ Fnn ;age I ill—
L5 Hullding Selbacks ----
Fn:Ptnl Yip•! � Side YJtds Hrar Y:ud_.___.
RryuurJ _... .._�'ru,lu:! I Hyumrtd Provldetl Htyun ed i': n,J:J
1.6 1Yater Supply: (NI L c. 40. $`y; I 1.7 Flood Zone Information: 1.8 Sewage Disposal System:
/ Lme. Outside Flood Zone"
Puhfic f.Y Prnatc ❑ — �� .Municipal n ,ne dc:poaal ,,.Irn! ❑
Check It yes JI
SECTION 2: PROPERTY OWNFRSH1P1
r .1
_'.1 Owner'
of Record: 34
Addre„ li,r Srn lee:
_c7 8 7g5 - 6s19
tiigl• _ — Felephune
SF C rr�)N a: DF:S<'I21F'TIS)N OF PROPOSED WORK"(check all that apply) --��
. r._ CuptedL�et ❑
n;truituln U. Building ❑ U,sner p t Jo:l
DemuU un _ p letx„cry B dti ❑ :urt b r of L!nits of her ❑ Seriiy
Brief Dr,• rIpt Ion sit Prop. :ed Wo,k m t_L_QN
I
�— SECTION 4: ESTIMATED CONSTRUCTION COSTS
[sumated Coots: Official Use Onl
(fem
rl ahorand %luten:dsl I y
I Building ) Q O 1. Building Permit fee. $-- Indl::ne bust tee ;. de!a nosed.
❑ Standard 0W-Fusin .\pphra:um Fee
'. F7ecvrcal 5 t
❑ Total Project Cosl (Item 6) c multiplier ,
? Plunhing 'S I �. Other Pees: 'S �\
-.---
__ _
i \1Ci hanli.Il (Fire 1` rotal�u :\II Fees 1 nc„enl I
( heck No __l�hc•cA .\mnunl _ _('.nh
.I, rof al Project Cost t 000 0 Paid In Full ❑Ount.uldiliv B,II.In.e 1?1le
— SECTION 5>_CONSTRUI"PION SERVII'FS - ---- -- --- — �
5.1 Licensed Construction Super%isor C'SIA
I Lui,ne \uud,er I:,pit.Wtm 1)ale '.
\awe�d ('SL Il"Ider -
1.1,1 ( SI. I\pe i,ee hilu„ __---
1 I ❑t e,InNliJ slit " IMIII IU 1`I _
R Rr,nmc &_' fCunil, Il,,:llut_e — _— __.I
R iJcntul R",gntL
I'i hpltu,t__ ___._-- �\\S A,id,nli.J \\utJ� �, ,t J \ I',u •_ _ _ _
- 51 R,,iJ.in,.tl S�tI,J I .nl ll tun u`\L,LI
DR.•,iJi nli.tl Ui n,t�hli� n _-__ -____.-__-___�
5.2 Registered Ilome Imprlryement Contractor (AIC)
HIC C'tnnp,u- Nallle or f11C Reel+lun aloe _.- Rcgulrauun Nuuthcr
\ddres,
Fapuao.nl atc
SIgnuture releplume
SECTIO 6: WORKERS' COMPENSATION INSURANCE AFFIDAVIT (M.G.L. c. 152. § 25C(6))
Workers Compensation Insurance affidavit ntn a completed and ,ubmitied wi(h (hit application. Padurc tit pan Ide .
(his affidavit will result in the denial of th nuance of the building permit.
Signed Affidavit Attached? Ye: .......... ❑ No .... .. . ❑
SECTION 7a: OWNER AUT ORIZATION TO BE COMPLETED WHEN
OWNER'S AGENT OR CONTRACTOR APPLIES FOR BUILDING PERMIT _
1. /K. 'A '"- 'Z as Owner of the subject property hcrebv
authorize S e 17C to act on my behalf. in all nutters
relative to w,n k au ,", QLbhis building permit application.
I
I
7-7 _0
Slenat 10 tier Date
SECTION 7b: OWNFRI OR AUTHORIZED AGENT DECLARATION
1 .)o Llr r wctHyr—tom , as Owner or Authorized Agent hereby, declare
that the statements and information on the foregoing application are true and accurate, to the best of my knowledge and -
I behalf.
Ski
Numc -
Slenamrr of O tier or Authorized Agera Date
t51 n d under the arcs and penalties of e(u I
NOTES: _
I. .An Owner who ohtams a building permit to Ju his/her own Nvork,or an owner who hires :ul unregistered i,nur.t.t�rc
(not registered In the Home Improvement C'ontrachr (1110 Pntgrdm), will nut halve acce., to me .uhilialwn j
program or guaranty fund under M.G.L. c. 142A. Other important mlLrmauon tin the I IC Pmeram .end
Conanucuon Supervisor Licensing WSLI can he found In 780 CNIR Regulations I I0R6 and 1 II) R5. re,peNtl,cle
' When substantial work is planned. pn,Ntde the Intitrmauon below
Vaal doors area (Sy. H) Imcluding garage. finished ha,cntent/atrtcs. dcck.N or p,n.h,
Gross hclne area t Sy. Ft.l Hahudble room Corm
Number tit fireplaces_ Number nl hedroum, _.
Numher or h.uhntom, - _ Number Od h.d 11+,1011
Numhertddcvk,/ pta,hc, -
1-Npe t J
?. Total Project Syu.lre Fooi.lge- nlay he ,uh,tituted t,tr rttr.d Prolecl