115 BOSTON ST - BPA-2L012-533 SECTION OF FOUNDATION + The C'onmtonwealth ot'iMassachuselts
Board of Building Regulations and Standards CITY OF
)' Massachusetts State Building Code. 780 C NIR 5,\LL\I
'y,•• .
IBuilding Permit Application 'ro Construct. Repair, Renovate Or Demolish a llr ri.rrJ l brr'll l/
OM'or Two-fanulr Dwellim,\r
y� J this Section For Official Use Only
Building Permit Number Date Appl'•d:
�t�V.C. zrl os�Gl� --
lluiWmg Olhcial(Print Muriel -
St re Uutc
SECTION I:SITE INFORAfATION
L I Proper( r uS-I-ou L2 Assessors Map& parcel Numbers
ll �61
L I a Is this an accepted street?yes no Map Numher Parcel Numhcr
1.3 Zoning Information: 1.4 Property Dimensions:
Zoning District Proposed lJs�_ Lot Area i It)L4 Fro nt age111)
I.S BuflJingSetbacks(R)
Front Yard
Site Yards Roar Yard
Required Provided Required y Provided Required Provided
1.6 Water Supply:(M.G.1.c.40.§Sq) 1.7 Flood Zone Information: 1.8 Sewage Disposal System:
Public 9 Private❑ Zone: _ Outside Flood Zone? /
Check fifes❑ Municipal -� On site Jispowl system in
2.1 Owner(of Record: SECTION2: PROPERTY OWNERSHIP'
Name(Print) `lQ/Z I9II�
{Z} Ciq•.State.ZIP-
t->le3o>�YLrr�J�� �1-694BS69
Nu.and Street Tele hone
D Email Address
SECTION J: DESCRIPTION OF PROPOSED WORKS(check all that apply)
New Construction ❑ Existing Building Owner-Occupied Repairs(s) V Alteration(s) ❑ Addition ❑
Demolition Accessory Bldg.❑ Number of Units Other ❑ .Specq: e
BriefPescrip ion of Proposed Work:: f ON N /Da
D0 t I N r?r� Dr I t V /z f - 0 / ^�
npN I N Y
SECTION 4: ESTIJIATED CONSTRUCTION COSTS
�t t
Item Estimated Costs:
I Labor and.\laterials) Official Use Only
I. Building S ' S r�g I. Building Permit Fee: S Indicate how fee is determined:
2. Lleclrical S ❑Standard City/Town Application Fee
7. PlumbingS ❑Totol project Cost'(Item 6)x multiplier _x
�2 0 '. Other Fees: S
4. .Medwilical III\.1(') S List:
5. \Icdlanical (l ire
Suivcision1 S Total .\11 Fees: S_-- -
n. Total Project Cosh S I�Zt &Q'� Chcck No. -_ ('heck:lnumltt: _ Cash \1110umt:
❑Paid in Full 0 Outstanding BaLnce Duc:
1
SE('TION S: ('ONSTRli(71'10N SF.RVI('F.S
.4.1 Construction Supervisor License(C'SL) �s Zr-
is, I
, r -- -
_ License I��pir;ttiol :ne
N:unc ul l'�L I'alder I i.st CSl. l'Npe Lice helo%0 ----
��t (v7 I N 1{7 f( O V� _. I.)p Description
No—tild Street (i (innsuicteJ(BuilJin Is ti to iS,UUtl at. 11.1
� �J� /fir ff �+ ��,/� R Restricted I&2 family Dwellin
JSJLLt=rZ—K-�---��l�i---- vl Slason
C'il)i loon,Slate.LIP
RC Rtwtin Coverin
WS µ'indow;utd Sidin
SF Solid Fuel Burning Appliances
I Insulation
Icichone ? ' L 7 Fnluil address D Demolition
5.2 Registered Home Improvement Contractor(HIC) 101671
6 'Z ' /
IIIC'Registr;awn Numher lispiratil 1 Dole
IIIC'Compaq N;uneurIIl teguvuntNuntu 66 �Nqaec'Tam, CAHeArrt 'U
5�Asr Email address
Nu.and Street '7-7
City/Town,State,ZIP O/ Sf rele hone
SECTION 6:WORKERS'COMPENSATION INSURANCE AFFIDAVIT(M.G.L c. IS2.' 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 .......... Cl No
SECTION 7a: OWNER AUTHORIZATION TO BE C0111PLETED WHENOWNER'S AGENT OR CONTRACTOR APPLIES FOR BUILDING PERMIT
I, 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.
U ll rLI'4VA— 067 1 at 4 a c �
Dut
Print Owner's Nate(Electronic Signature)
SECTION 7b:OWNEW OR 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 7/t b of my knowledge and understanding.
6fv!.yA);64►� mac- S �o
o Dale
Print Owner's or:\ulhun/eJ Awllt s Noma Ih •c rune Slgn.aunl
VOTES:
I. : Owner whu obtains a build ing permit to do his.her own work,.,)ran an owner who hires an unregistered contractor
}n
(not registered in the Hume Improvement Contractor(HIC) Program),will nrr have access to the arbitration
program or guaranty fund under I.G.L.c. 1 4'_A,Other important information on the HIC Program can be round at
,,,,o 111.1" , o, l information on the Construction Supervisor License can be found at dil,
2. }}'hen substamial work is planned, provide the information below:
n.) _ ______I including garage, finished basement attics,decks or porch)
Total fluor area(4
Gross (icingarea try. 11.1 _
Habitable foul',count —_. ...._
Number oflireplaces. ._ \lultherufbedrounli . ...- -- .. -. . .
�'unlhen,l'hathrooltls �unlbcr of hall hutlls
i l�pc of he;uing o stem Number of decks, porches
Enclosed _ _ -.Open
I" ol'0101illu,
} h,dal I'rojcd Square Footage"ma) he;uhstinncJ thr' total Project C'usl"