11-13 BOSTON ST - BPA-2010-99 DECK BOARDS a
The Commonwealth of Massachusetts Town of
Board of Building Regulations and Standards
Massachusetts State Building Code, 780 CMR, 7'"edition
�t� Budding Dept
Building Permit Application To Construct. Repair, Renovate Or Demolish a
One- or Tn'u-Fuind.r Du elling
This Section For Official Use Only
Building Permit Number: I Date Applied:/ G
Signature: — 7` •7 �
Budding Commissioned Inspector of Buildings Date
SECTION I: SITE INFORMATION
.1 Propy y}Agre�ss 1.2 Assessors Map At Parcel Numbers
1.la Is this an accepted street'?yes_ no Map Number Parcel Number
1.3 Zoning Information: 1.0 Property Dimensions:
Zoning District Proposed Use Lot Area(sq n) Frontage(II)
1.5 Building Setbacks(ft)
Front Yard I Side Yards Rear Yard
Required Provided Required Provided Required Provided
1.6 Water Supply: (M.G.L c.a0.15a) 1.7 Flood Zone Information: 1.8 Sewage Disposal System:
Public❑ Private O Zone: _ Outside Flood; Municipal❑ On site disposal system ❑
Check if es❑
SECTION 2: PROPERTY OWNERSHIP'
2.1 Owner'of Record• �0
Name y0p Address for Service:
Si�e Telephone
SECTION J: DESCRIPTION OF PROPOSED WORK'(check all that apply)
New Construction O Existing Building❑ Owner-Occupied ❑ 1 Repairs(s) ❑ Alteration(s) ❑ Addition ❑
ry 8
O Accesso Bid .❑ Number of Units_ Other O Specify:
Demolition
Brief Description of Proposed Work':
SECTION!: ESTIMATED CONSTRUCTION COSTS
Item Estimated Costs: Official Use Only
Labor and Materials
I. Building f I. Building Permit Fee: S Indicate how fee is determined:
❑Standard City/Town Application Fee
2. Electrical f ❑Total Project Cost'(Item 6)x multiplier x
J. Plumbing S 2. Other Fees: S
4. .Mechanical (HVAC) S List: G
5 Mechanical (Fire S
Su ression Total All Fees: f
Check No. _Check Amount: Cash Amount:_
b. Total Project Cost: S �Q 0 Paid in Full 0 Outstanding Balance Due:
At
SECTIONS: CONSTRUCTION SERVICES
5.1 Licensed Construction Supervisor(CSL)
License Number Espvotion Date
N;poe of CSL Helder List CSL Type Ixc below)
•
Ts De Dexn uon
Address
U Unrestricted(up to 35,000 Cu. Ft.)
R Restricted I&2 Family Dwelling
Signature M Mastrnry Only
RC Residential Roofing Covering
Telephone w5 Residential Window and Siding
SF Residential Solid Fuel Burning Appliance Installation
D Residential Demolition
5.2 Registered Home Improvement Contractor(HIC)
HIC Company Name or HIC Registrant Name Registration Number
Address
Expiration Dale
Signature Telephone -
SECTION 6:WORKERS'COMPENSATION INSURANCE AFFIDAVIT(M.G.L.c. 152.1 2SC(6))
Workers Compensation Insurance affidavit must be completed and submitted with this application. Failure to provide
F
avit will result in the denial of the Issuance of the building permit.
ffidavit Attached? Yes.......... O No........... ❑
N 7a:OWNER AUTHORIZATION TO BE COMPLETED WHEN
'S,A/GENT OR CONTRACTOR APPLIES FOR BUILDING PERMIT
//N ��/fIefa f as Owner of the subject property hereby
to act on my behalf,in all matters
work authorized by this building permit application.
f Owner Date
SECTION 7b:OWNER'OR AUTHORIZED AGENT DECLARATION
as Owner or Authorized Agent hereby declarJand
that the statements and information on the foregoing application are true and accurate,to the best of my knowledge
behalf.
Print Name
Signature of Owner or Authorized Agent Date
Si tied under the pains and penalties ofperjury)
NOTES:
I. 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 fW have access to the arbitration
program or guaranty fund under M.G.L. c. 142A. Other important information on the HIC Program and
Construction Supervisor Licensing(CSL)can be found in 780 CMR Regulations I IO.R6 and I IO.RS, respectively.
2. When substantial work is planned,provide the information below:
Total floors 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 halfbaths
Type of heating system Number of decks/ porches
Type of cooling system Enclosed Open
1. "Total Project Square Footage'may he substituted for 'Total Project Cost'