58 BOW ST - BPA-14-675 INSULATION Ll
7�
_..-.__.-.___ _
The Cool nonncallh of Massachuscits
Board of Building Regulations and Standards CI"I'Y OF
sr ;, Massachusetts State Building Code, 780 C'MR S,\LL'\I
Building Permit Application 'ro Construct, Repair, Renovate Or Denwlish a
One-or Tlvu-F intil' Uu elling
this Section For Official Use Only
Building Permit Number. Date Applied:
Building Otlicial(Print Mum) Signature Oute
SECTION I: SITE INFORMATION
1.1 Pro rty Address: 1.2 Assessors Map& Parcel Numbers
I.la Is:his an accepted sire..?yes no Map Numher t'urccl Num—he r
1.3 Zoning Information: 1.4 Property Dimensions:
Zoning District I'n+pus.d Use Lot Area(sq 11) - Fmnutge(Ill).
1.5 Building Setbacks(R)
Front Yard Side Yards Rcar Yard
Required Provided Required Provided Required Provided
1.6 Water Supply:(M.G.I.c.40,5 Sq) 1.7 Flood Zone Information: 1.8 Sewage Disposal System:
Public❑ Private❑ Zone: _ Outside Flood Lon.? Munici al❑ On site disposal s y.stun ❑Check fifes❑ p po'
SECTION+2: PROPERTY OWNERSHIP'
2.1 wnerl of Record.
U/r-- Uer
N;nic(Print) C uy.State.ZIP
3S 7�'v ZV,"-1 ..1-7*
U.and Street Telephone Finail Address
SECTION J: DESCRIPTION OF PROPOSED WORK'(check all that apply)
New Construction❑ Existing Building Repairs(s) Cl 1 Alteration(s) ❑ Addition ❑
Demolition ❑ Accessory Bldg.❑ 1 Number of Units Other Spccily:
Brief Description of Proposed Work-:
4al tmi
SECTION 4: ESTIMATED CONSTRUCTION COSTS
Itcm Estimated Costs:
(Labor and.Materials) Official Use Only
I. Building S I. Building Permit Fee: S Indicate how fee is determined:
'. Electrical S ❑Standard City/Town Application Fee
❑Total Project Cost'(Item 6)x multiplier _ _.x _
1. Plumbing S 2. Other Fees: S
a. >kch:mieal illy.\(') S List:
._----
tiu++nssionl S Total .\11 Fees: S .___._._.. .
Total Project Cost: S sCl^/s �� Ch"k No. _('heck Amount: _ Cash \im mnl:
J—U[ 13 P;iid in Full ❑Outstanding Balance Due:
SECTIONS: CONSI'RIICTIONSERVICES
5.1 Construction Supenisur License(CSt.) ��uiz.3 S rS
j WA'R.a
LicanscNunther I �tir: iouU;ue
_3 �C� � ...__"__ list CSL f)pc Vee hcluwl.____.—__—
.Sueel -- -- ---"----- _ 1'�pe Description
,� (itl Inresrictcd I IluilJii gs L al 15,000 eu. it
f`"r^"M c r` e` a . . R KcarictcJ Lr?Famil Y MwI1111
lI ifown.Shue,/IV ""- - —'— M Masoiry
RC R(K)II11it Covering
...—._ WS Window and Siding
SF Solid Fuel Burning Appliances
92�Zyr,�y��_ /-c�,r�'wK� (,orbEtC7•�''� I Insulation
'I'elc hone Fnwil address D Demolition
5.2 rRegistered Home//teumen Improvement Contractor( I ICS�Q )yt
®"e'•'r r 4 C I IIC Registration Numhcr Expiration Date
I IIC'(;ym ;one or I IC'I(c lran mn¢
Nu.:mJ S y, . d � 2� /�,Zq', 2r1� �Prr Email address
City/Town,State,ZIP Z rrelc honne C
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
this affidavit will result in the denial of the Issuance of the building permit.
Signed Affidavit Attached? Yes ......... No...........❑
SECTION 7a: OWNER AUTHORIZATION TO BE COMPLETED WHEN
OWNER'S AGENT OR CONTRACTOR APPLIES /FOR BUILDING PERMIT
I, as Owner of the subject property,hereby authorize r �'f� � ,-144 ,4_tpAr (
to act on my behalf,in all matters relative to work authorized by this building permit application.
Pent Owl (Electronic Signature) Date
SECTION 7b:OWNER( 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 accurate to the best of my knowledge and understanding.
sr K
Print Owncr's ur:\ulhorireJ.\gau's N;unu fflcctrunic Signuturu) ate
NOTES:
I. An Owner who obtains a building permit to do his.her own work,or an owner who hires an unregistered contractor
(nut registered in the Home Improvement Contractor(HIC) Program).will nu have access to the arbitration
program or guaranty fund under M.G.L.c. 1 2A.Other important information on the HIC Program can be found at
www 111A, 10n ,.k,I Information on the Construction Supervisor License can be found at
2. \\'hen substantial work is planned, provide(he inl'unnaliun below;
Total flour area(sq. ft.) _ (including garage, finished bascnwnt attics,decks or porch i
Gross (icing area I sq. 11.l _ _ _."._ __.." _ _ habitable room count
Number of fireplaces.__. Number of bedrooms -
iNunther of hathrooms _ \'weber of half halts
I)lie of heating s)stem Number of decks, porches
I 1\Pe 0l eJ01lltg it itdlll I,IICIJ5CJ
1. "fodol Project Square Foomec'.may he suhsiouted t'ur-l'olal Projeel Cost"