20 BRADFORD ST - BPA-16-206 HC RAMP The Commonwealth of Massachusetts FRevisedAhir
O W
Board of Building Regulations and Standards Massachusetts State Building Code, 780 CMR
Building Permit Application To Construct, Repair, Renovate Or Demolish a
One-or Avo-Family Dwelling
This Section For.official Use only
4 Building Permit Number. Date.Appiiedt
-DuilJing Official(Print Name). Siyrature
SECTION It SITE INFORbIATION.
1.1 P tyl7r2 r }+y � e/ 12\esson blap&Pn 1 Numbers
GO
I.1 a Is this an acce ted street?yes_ no Map N r ber Pa l Number
1.3 $btling Information: 1.4 Prop ty Dimenslons:
Zoning District's,.:- Proposed Use Lot Area(sy tl) Frontage(11) - -
I:S,Building Setbacks(R)
'� Front Yard_ - - Side Yards - Rear Yard.
�
Rcyuired Provided Required Provided. Required- - Provided
1.6 Water Supply:(M.G.L c.40,§54) L7 Flood Zone Information: 1.8 Sewage Disposal System:
Public❑ Private❑. Zone: _ Outside flood Zone? Municipal O On site disposal system ❑
Check if es❑
SECT[ON 2. PROPERTYOIVNERSH411-
;WW—Fae(Pei - Ci State,ZIP f -
20
No.and Street Telephone 1 Email Address
SECTION 3:DESCRIPTION OF PROPOSED WORK'(check all that apply);
New Construction❑ Existing Building❑ Owner-Occupied ❑ Repairs(s) ❑ Alteration(s) ❑ Addition ❑
emolition ❑ Accessory Bldg.❑ Number of Units_ Other ❑ Specify:
scri on of Pro ose I W
�� 1 W/Iep&
SECTION 4:ESTIMATED CONSTRUCTION COSTS
Item Estimated Costs: OfR al se Only
Labor and Materials) -
1. Building $ I. Building Pemut Fee:S Indicate how fee is determined:
❑Standard City/Town Application Fee
2. Electrical S ❑Total Project Cost'(item 6)s multiplier s
3. Plumbing S 2 other Fees: S
4.Mcchanical (tIVAC) S - . - List.
5. Mechanical (Fire
Suppression) Total All Fees:S
A No._Check Amount: Cash Amount:
6.Tutal Project st: S j�JflU_ ❑p;ti in Full ❑Outstanding Balance Due:
P. V . -j ( It �(1 Y{• Q .
SECTION 5: CONSTRUCTION SERVICES
i
5.1 Construction Supervisor License(M)
License Number Expiration Dale
Name of CSL Holder
List CSL'fype(see below)
Type - - - Description .
No.and Strect -
U Unrestricted(Buildings tip-to 35,000 cu. It.
R Restricted 1&2 Family Dwelling
City/fo%Jn„stone,ZIP M Masonry
i+t� RC Roaring Covering
WS Window and Sidinst
SF Solid Fuel Burning Appliances
1 I Insulation
T
elephone Email address D Demolition
Home Improvement Contractor(HIC)
HIC Registration Number Expiration Date
me or k11C Registrant Name
Email address
oe ZIP Telephone
SECTION 6:WORKERS'COMPENSATION INSURANCE AFFIDAVIT(M.G.C.c.151§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 Wintrice of the building permit.
Signed Affidavit Attached? Yes ..........O No...........O
SECTION 7a:OWNER AUTHORIZATION TO B&COMPLETED.WHEN•
OWNER'S AGENT OR CONTRACYOR APPUES FOR BUILDING.PERMIT'
I,as Owner of the subject property,hereby authorize
t9 act on my behalf,in all matters r ative to work authorized by this building permit application.
- I tilt :31 o i
Print Owner's Name( ectmnic signature) D to
SECTION 7b:OWNEW OR AUTHORIZED AGENT DECLARATION
By entering my name below, i hereby attest under the pains and pen Ities of perjury that all of the information
contained in this application is true and accu to to th best of t o dge and understanding.
Print Owner's or Authorized Age is Name(E cctronic Signmture) Date
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 Inpirovement Contractor(HIC)Program);will nu have access to the arbitration
—
program or guaranty fund under NLG.L.—c. 142A.-Other tmpaitant informanon on the HIC-Program can b—e Ioun at
ww.v mas�.euv;'oca Information on the Construction Supervisor License can be found at www.ntass."ov/Jus
2. When substantial work is planned,provide the information below:
'total floor area(sq. ft.) (including garage, finished basementlattics,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
'Type of cooling system Enclosed- Open
3. "Total Project Square Footage"may be substituted for"'futal Project Cost"