124 BOSTON ST - BPA-2010-414 UNIT 3, CABINETS Ck--x:p 1-717 y
The Commonwealth of Massachusetts Town of
y r Board of Building Regulations and Standards �w
I\ t`�� Massachusens State Building Code. 780 CMR. 7'"edition Building Dept
1V�1 Building Permit Application To Construct. Repair. Renovate Or Demolish a
One- or Tiiu-funsth'Durffrng
This Stoftirs For Official Use Onl
Building Permit Nu ber: 4 1 IDAre A lied:
Signature:
Blding Commissioner inspator of Btu i -dam
ui
SIECT1451)(1401TE INFORMATION
I.1 Pr rt ddrn& 1.2 Assessors Map R Parcel Numbers
AlqEw 1.la Is this an acc ted street"yd no
M Number Parcel Number
IJ Zoning Information: 1.4 Property Dimensions:
Zoning District Proposed Use Lot Area Isq III Frontage(R)
IS Building Setbacks(R)
Front Yard Side Yards Rear Yard
Required Provided Required Provided Required Provided '
1.6 Water Supply:(M.G.L c.40,Sse) 1.7 Flood Zone Information: 1.2 Sewage Disposal System:
Zons: _ Outside Flood Zone? Municipal O on site disposal system O
Public O Private O Cheek ifyet,
�l SECTION 2: PROPERTY OWNERSHIPt
2`jem�far AF,iS ge�T017' S�
iZlame iPrinq �Addrcu for Service:
Signature Telephate
SECTION J: DESCRIPTION OF PROPOSED WORKa(check all that apply)
New Construction O Existing Building O 1 Owner-Occupied O Repairs(s) O Alteration(s) O Addition O
Demolition A Accessory Bldg.t] 1 Number of Units_ Other O Specify:
rr.
eej�d c
Brief Descririipti^ pp
-�Pros Work
y: o r
SECTION 4: ESTIMATED CONSTRUCTION COSTS
Estimated Costs: Official Use Only
Item Labor and Materials
I. Building f I. Building Permit Fee: f Indicate how fee is determined:
O Standard City/Town Application Fee
2 Electrical S O Total Project Cosl'(Item 6)a multiplier, x
Plumbing S 2. Other Fed: f
a. Mechanical (HVAC) f List:
1 Nechanical (fire S Total All Fees: f
Slip--ression
Check No. _Check Amount: Cash Amount:
is Total Project Cost S, ❑ Pad in Full 0 Outstanding Balance Due:
II� �
SECTION 5: CONSTRUCTION SERVICES
5.1 Licensed Construction Supers isor(CSL) ep/70 r
d
N,p 7/Rf�(Sz z ysK L n.n.e.Vumbrr E.pnauon Date
Nyae of CSL- Helder n �,}
Li�I CSL TyptIXY II�IUw) (X—
Type I Description
U Unrestricted(up to)7.000 Cu. Fl.
5i natnrc R Restricted Id2 Family Duelling
�t " d6• E�7 H %fasonly Only
9 RC Residential Rocifiner Covering
Telephone w'S I Residential Window and Siding
SF IResidential Solid Fuel Burning Appliance Installation
D I Residential Demolition
5.2 Reglstert d Home Improvement Contractor(HIC)
,7�/SK /'Dory-5 eU�r/off / ? zZ 3�p
HIC Company Name or HIC Registrant Name Regtstrauan Number
P -14r1-AQrw-5 �D TD�SF/��h
A sa t\ 97�- 6_G87� Expiration Dale
Signature Telephone
SECTION 6:WORKERS'COMPENSATION INSURANCE AFFIDAVIT(M.G.L.e. 152.§ 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 AllachaP Yes.......... O No........... O
SECTION 7a: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
redstive to work authorized by this building permit application.
sistruncistor0wricir Date
SECTION 7b:OWNER'OR AUTHORIZED AGENT DECLARATION
1, as Owner or Authorized Agent hereby declare
that the statements and information on the foregoing application arc true and accurate, to the best of my knowledge and
behal.
RP/US2
Print Napirnn /
Signature of Owner or Authorized A t Data
(Siarced under the pains and penalties of
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 W have access to the arbitration
program or guaranty fund under M.G.L. c. I42A. Other important information on the HIC Program and
Construction Supervisor Licensing(CSL)can be found in 780 CMR Regulations I 10 R6:and10.R5, respectively.2When substantial work is planned, provide the information below:Total floorsarea(Sq. Ft) (including garage, finished baseme ,decks or porch)Gross living area(Sq. Ft.) Habitable room count
�N'umber of fireplaces Number of bedrooms
Number of bathrooms Number of half baths
Type ofheating system Number of deckv porches
TYpeofcoolingsystem Enclosed
1 "Total Project SOare Footage"may he.uh.uluted for 'Total Project Cost"