19 BOSTON ST - BPA-2010-308 WINDOWS r
The Cumnionwcalth of Massachusetts Town of
Board of Building Regulations and Standards
Massachusetts State Building Code, 780 CMR. 7'"edition Building Dept
Building Permit Application To Construct. Repair. Renovate Or Demolish a
One. or Two-Fund Dwelling Amos
This Secuon,F r Official Use Onl'
Building Permit umber! 11 Date pplied:
1 Signature: / � ��
Building Commissioner/Inspector of Btnldm Date
SECTION I SITE INFORMATION
1.1 Property Addresr 1.2 Assessors Map d Parcel Numbers
1.1 a Is this an accepted street:'yea V no Map Number Parcel Number
1.3 Zoning Information: 1.4 Property Dimensions:
Zoning District Proposed Use Lot Area(sq R) Frontage(B)
1.5 Building Setbacks(ft)
Front Yard Side Yards Rest Yard
Required Provided Required Provided Required Provided
1.6 Water Supply:(M.G.L c.40.154) 1.7 Flood Zone Information: 1.8 Sewage Disposal System:
Zone: Outside Flood Zone? Munici al O On site disposal system O
Public O Private 0 — Check if sO p
SECTION 2: PROPERTY OWNERSHIP'
2.1 wnerlof
S or
Name IPrint) t Address for Service:
Signature Telephone
SECTION l: DESCRIPTION OF PROPOSED WORK'(check all that apply)
New Construction O Existing Building O I Owner-Occupied O Repairs(s) d Alteration(s) O Addition O
Demolition O Accessory Bldg.O Number of Units_ Other O Specify:
Brief Description of Proposed Works: 0 �
SECTION 4: ESTIMATED CONSTRUCTION COSTS
Item Estimated Costs: Official Use Only
Labor and Materials
I. Building f��.5�U. co 1. Building Permit Fee: f Indicate how fee is determined:
O Sundard City/Town Application Fee
2 Electrical $ O Total Project Cost'(Item 61 x multiplier x
J Plumbing f 2. Other Fees: f
4. Mechanical (HVAC) f List:
5 Mechanical (Fire $ Total All Fees: S
Su remon
Check No. _Check Amount: Cash Amount:_
6 Total Project Cost �LS U Q , O Paid in Full ❑Outstanding Balance Due'
35`a d
SECTIONS: CONSTRUCTION SERVICES
5.1 Licensed Construction Super%isor(CSL)
License Number Espuzuon Datt
N.yx tit CSL Helder n �.,n_ f� List(St
Type J cc b0ow) J
AJdrcs - Q(`(3�j T Description
_ U Unrestricted u to 15,000 Cu. Ft.
R Restricted IA2 Family Dwel6n
Siang a .M Nlawnry Only
(--6 �f— RC Residential Rooting Covering
Telephone W S Residential Window and Siding
SF I Residential Solid Fuel Burning Appliance Installation
D Residential Demolition
S.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. 152.J 2SC(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 Alrtdavit Attached? Yes.......... 0, No........... O
SECTION 7a:OWNER AUTHORIZATION TO BE COMPLETED WHEN
OWNER'S AGENT OR CONTRACTOR APPLIES FOR BUILDING PERMIT
I. Z}.^ti.0 Q (/v,+A U fL-R— as Owner of the subject property hereby
authorize�L L—I�Z/���"`ri^2 W��— to act on my behalf,in all matters
relative to work aut by this building it application,
Signarum o net Date
SECTION 7b:OWNERt OR AUTHORIZED AGENT DECLARATION
rrad
as Owner uthorized Agent he y declare
ments and information on the foregoing application arc true and accurate,to t e y owledge and
oe Authorized Agent Date
helisms and penalties of perjury
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 M 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 1 IO.RS, respectively.
2. When substantial work is planned,provide the information below
Total floors area(Sq. Ft.) (including garage, finished basemenVattics,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
Tv pe of cooling system Enclosed Open
1 "Total Project Square Footage" may he substituted for"Total Project Cost"