108 BOSTON ST - BPA-12-648 SIDING �� 7 l he C'unmwnweahh of Mussachuscus --
',� Board of Building Regulations and Standards CI FY OF
't MLlssachusetts State Building Code. 7SO CNIR SALIi\I
Building Permit Application 'ro Construct, Repair, Renovate Or Demolish a
One-or Ttvo-Fami/1 Dwellinkr
This Section For OBict Use Onl
Building Permit Number: Da Applied:
Ituilding 011icial(Print N;uno) Signalure Duic
SECTION I:SITE INFORNIATION
1.1 Property Address: lO �^ C d� `L 1.2 Assessors Map& Parcel Numbers
1,Is Is this an acre ted street? 'es (�J no Map NuntM;r Force]Numtnr
1.3 Zoning Information: 1.4 Property Dimensions:
Zoning District Proposed Wo Lill Area Isq Itl Frontage(It)
1.5 Building Setbacks(R)
Front Yard Side Yards Rear Yard
Required I Provided Required Provided Required Provided
1.6 Water Supply:(M.G.I.c.40.§54) 1.7 Flood Zone Information: 1.8 Sewage Disposal System:
Public❑ Private❑ Zane: _ Outside Flood'Lune? Munici el❑ On site dis sal s-ucm ❑
Check it' �cs❑ P W >� '
SECTION2: PROPERTY OWN ERSHIP-
2.1 Ownord:er- f Rec j c} 2
iv y6y�C2 S0)I "I ,/Y22
Nwne(Pool) Lily,date,ZIP
/oss !nc�-k ✓ -C�/. I - W Ya/ewl'v& tia�ir
Nu.and Street Telephone Food Address
SECTION J: DESCRIPTION OF PROPOSED WORKS(check all that apply)
New Construction❑ Existing Building❑ Osvner•Occupied ❑ Repairs(s) ❑ I Alteration(s) ❑ Addition ❑
Demolition ❑ Accessory Bldg.❑ Number of Units_ Other ❑ Specify:
Brief Description of Proposed Work':
SECTION 4: ESTIMATED CONSTRUCTION COSTS
Item Estimated Costs:
iLaborand.\htterials) Omclal Use Only
I. Building S I. Building Permit Fee: f Indicate how fee is determined:
2. Fleclrical S ❑Standard CityrTuwn Application Fee
❑Total Project Cost-(Item6)x multiplier
_.— .x
7. Plumbing S 2 — - ..----
. Other Fees: f
J, \Iedianical III \(') S List:
_ c
\lechaoical Wire
Cup]ncssionl S Total .III Fees: S_
Check No. ('heck amount: ('ash \nunutt:
Tutul Project Cost: S 60 --.
2 �CJG � ❑ raid in Fouilll ❑Outstanding Ilul:mco Doc:
St.'( I ION 5: CONS I-RUcrIONNERVICES
5.1 Construction Supervisor License((St.)
f.'%litraiwo Date
N-ailic ol'01. I lol&r I ist CS I. I)Ix(,ec 1100%v1
---------- 1.1,PC Description
No. and sirvet t I t I nrv.N tri cied(I I ki i I d i ii p to to 3 1.000 L a
R Re.,triocd NU 1�joiilj MwIliog
010 om)."'tate,/11' %1
KC
A Nk ,
S Windim and Siding
SF Solid Fucl Burning Appliances
I
D
Insulwion
1 c1cpholic himil�addrcsi D
Denxlliliun
5.2 Registered Home inij)ro%,enieiitCositr:iclor(ollIC)IA
IIIC Registration Nuruh6r F%piration Date
I IIC Compan) Name or IlIC Registrant Name
No.and Street Email address
City/Town,State,ZIP tale hone
SECTION 6:WORKERS'COMPENSATION INSURANCE AFFIDAVIT(M.G.L e. 152.1 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 Affidavit Attached? Yes ..........0 No...........(3
SECTION 7s:OWNER AUTHORIZATION TO BE COMPLETED WHEN
OWNER'S AGENT OR CONTRACTOR APPLIES FOR BUILDING PERMIT
1. as Owner of the subject property,hereby authorize
to act on my behalf,in all matters relative to work authorized by this building permit application.
Print 0%sner's Nanic(Electronic Signature) Date
SECTION 7b:OWNEWOR AUTHORIZED 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 application.is true and accurate to the best of my knowledge and understanding.
A/- /
Print oorier'.i orAothoritvdAgent's Name I 1:.Iectronic Signature) 'Date
NOTES:
1. An Oo,iier who obtains a building permit to do his,her own work,or an owner who hires an unregistered Quiuractur
(not registered in the Hume Improvement Cuntrac tar i H IC) Program).wi 11 1U) 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
k%\%k\ MA'.1 '\ .11.1 Information on the Construction Supervisor License can be found at
2, \ lien substantial%%ork is planned,provide the information below:
row floor area I sq. R,l 1 including garage. Imishcd basement.attics.decks or porch i
Gross li%ing,irea i sq. fU Habitable room count
\jimber of rcillaces Number ofbcdroonis
Ntimberot'liathrooms Notillicr ofliall,halfis
1*\lie of heating i%ilem %,uinbvrofdceks, porches
1*,\pc ol'Q"ollllg i1 stem 1'iiclosed -.01'en
I 'roj"t Square Footage-1,1a\ be substituted for l'o(al Project Cost"