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8 BUCHANAN RD - BPA-12-123 1 The Commonwealth of Massachusetts 1 I Board of Building Regulations and Standards CITY e ,J Massachusetts State Building Code,780 CMR, 76 edition ReOv sr ed J EM `I nuary Building Permit Application To Construct,Repair,Renovate Or Demol' h a 1, 2008 One-or Two-Family ing Cs,Secfioil` ot;( fglai tnly ri- Bnilding�isennu Niimber'� 7"`;ate i 3'„ . $ignature '�wrr�an ; '. t $utl mg C togfnm�ssnerl(g (fiebfos _..u, Y 1.1 Property Address:_ ,Q 1.2 Assessors Map&Parcel Numbers — $;� dif" X- eq r 7mm 1.1 a s tI" his an accepted street?yes no Map Number Parcel Number 1.3 Zoning Information: 1.4 Property Dimensions: - Zoning District, Proposed Use Lot Area(sq 11) - Frontage(R) 1.5 Building Setbacks(ft) From Yard Side Yards Rear Yard Required Provided Required Provided Required Provided 1.6 Water Supply: (M.G.L c.40,§54) 1.7 Flood Zone Information: 1.8 Sewage Disposal System: Zone Outside Flood Zone Public❑ Private❑ — Municipal❑ On site disposal system ❑ Check if yes❑ 2:1 Own f Reco ._. $ECr Ol�i { PIL© li 3 Y il... SI#1Pt o C i / /ffC�t� w UG, � � Un Name(Pnnt) Address for Service: � �yy �i yoc Signature Telephone SECT I()N 3 DERIP Ib lR, HUSEI �WRZx(c+6ek all that aP.ply) New Construction❑ Existing Building❑ Owner-Occupied ❑ Repairs(s) ❑ Alteration(s) ❑ Addition ❑ Demolition ❑ Accessory Bldg. ❑ Number of Units Other ❑ Specify: Brief Description of Proposed Work': �I /1I5 Itp SECTION 4: GON9IJt T74NOSTS ` . Estimated Costs: Item Labor and Materials �. ,`;` ®fticia#>ITse Only 1.Building $ 1 Utl3mg F'ertCnt'Fee $ , Indicate_ bow fee is.determined: 2.Electrical $ £>7 Siandazd Ctly7Tox�MApI5libhhonTee CI Tonal Ertb(ee{ �t (Ttetttf6j x m4ltrplter x 3.Plumbing $ 4.Mechanical (HVAC) $ 5.Mechanical (Fire $ Suppression) Totala dff ie $ � Cheak 3�a �hedk Afnount Cash Amount: 6.Total Project Cost: $ p patdh Full ❑Outstanding Balance Due: '5( 5.1,Licensed Construction Supervisor(CSL) (e-jQ Mlc.�A P L License Number Expiration Date Name off CSL-Holder- List CSL Type(see below) y Address Unrestricted(up toa S Cu. R Restrictedl&2Familly Dwelling Signature �� M Mason Onl G}-7�:-7 13 - RC - Residential Roofm Coverin Teleph--one WS Residential Window and Sidin SF Residential Solid Fuel Burning ApPlience Installation D Residential Demolition 5.2 Re Were 1 H e I provement Contragt r(HIC) 40 � S u HIC Cogtpsn Name or C Red nt me G. Registration Number c� 7 -J=L/,J AddresG G 7�`7 �3(Z Expiration Date Signature / Telephone SECT.TON 6„WOItKjl t CQH�PIENSATI4idrlI II}ZANC ¢FFIllAVTT,(M.G.L,;c.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 Attached? Yes No........... 13 SFCCTIS)N:7a 11�1tIEI#AU1H()!lif�ACi�IYx 33FtG7 � �N OWIyER'SAGENT_UlCONTCTC1. API) IS=POItB k , as Owner of the subject property hereby I, authorize to act on my behalf,in all matters relative to work authorized by this buildin permit appli on. Si ature of Owner Date SEGTIONb U ) R Y .7 »k� IT 1ECLAHAFYON I _ p as Owner or Authorized Agent hereby declare that the statements and infotmatiot on the foregoing application are true and accurate,to the best of my knowledge and behalf. I j L /Print Name � - A//I, L Signature of Owner or Authonzed ABSat Date �Signed under the gains and venalties of petJu M 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 not have access to the arbitration program or guaranty fund under M.G.L.c. 142A.Other importantinformation on the HIC Program and Construction Supervisor Licensing(CSL)can be found in 780 CMR Regulations 110.R6 and 110.R5,respectively. 2. When substantial work is planned,provide the information below: Total floors area(Sq.Ft.) (including garage,finished basement/attics,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"maybe substituted for"Total Project Cost"