36 BUTLER ST - BPA-2009-205 The Commonwealth of Massachusetts —
t Board Lit 13u11ding RCguld(i011S and Standards H )It
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MassdchusCIIS State Building Code. 7SU (•MR. 7"'ediIiu0. SII VI( II' \IIIw Permit ApplicationToConstruct. Repair. RenovateOr Demolish ❑ Rr i v,,d.l w,
One '(1111th Duelling fr)('S
-his Sectio or Official Use Only
Qmit Number Date Applied:
1
Signature: — 6-•1._..- - .
Huddnig Guinn , neri In,pec K
iljzlgs Date
ACTION 1: SITE INFOR:AI:ATION _
1.1 Pro •rt , Addy s: �-y „ /7 �+� 1.2 :Assessors Slap & Parcel Numbers --— -
I.Ia Is this an acre�pwddA--strreeettt! Vees H ) Map Number Ru.rl N'umhei
L3 Zoning Information: 1.4 Property Dimensions:
Zomng District Proposed Use Lot Area(sq 11) Frunmge iit)
1.5 Building Setbacks (ft)
Front Yard Side Yards Rear Yard
Required Provided ReyuurJ Provided Required Pno,iJcd
I
1.6 Water Supply: tM.G.L c. 40. §54) 1.7 Flood Zone Information: 1.8 Sewage Disposal System:
Zone: _ Outside Flood Zone'!
Public ❑ Private❑ Municipal if yes❑ unicipal ❑ On sue disposals m te ❑
SECTION 2: PROPERTY OWNERSHIP'
t
2. e01ynef Reco ��, ''7�� t
Na c GGp .��iiHJ� AJdress�lor Service:
Ignature Telephone
SECTION 3: DESCRIPTION OF PROPOSED WORK'(check all that apply)
New 0 structiun ❑ Existing Building ❑ Owner-Occupied ❑ Repairs)s) ❑ .Alleraurm(a) ❑ r\JJitinn ❑
Demolition ❑ Accessory Bldg. ❑ Number of Units Other ❑ Specify: _
Brief Description of Proposed Work':
SECTION 4: ESTIMATED CONSTRUCTION COSTS
MEs ,�edsts:
Item Official Use Only
(Labor andMaterials)
1. Building $ I. Building Permit Fee: Indicate how kc a Jeternu nrJ:
❑ Standard City/Town Application Fee
2. Electrical ❑Total Project Gut' (Item 6) x multiplier x3. Plumbing2. Other Fees: 84. Mechanical (HList:5. Mechanical (FiSu) reSsnm) r,taiAll Fees: 5Check No. Checkamount: _ ('•t,h A +antb Total Projecto ❑ Paid in Full ❑ Oulstanding Balance Due_.---- -
f ° L [ C.1t17 G�
SECTION 5: CONSTRUCTION SERVICES
1 5.1 Licensed Construction Supervisor ICSI.)
I.ut CSI_ 'I.Ix,('cc hckm I
__- I.` c Ucsc11 num
t l nn>u telrJ 1 u) to i; 01)0( it 11.I
. R Re,tnevd Ih' lalnt IN Dwi111it_ _�,
S I .uure �J V \Lisonn Onh
RC R:,;Juuiul
re L•phum• \15 Re,lJrntl.�l \`.1nJm� ,1nJ 1u11u� __--____ __.___.
SF Rr.1J.1nta1 Sa11J 1-.ie1 tiulnl1c \ll`l i.ln�c Iu t.il Lit l� u
5.2 Registered Itome Improvement Contractor (111C) — z 1J
IilC C'unip.m) Name or HIC Regiwujil %am A Regt,tratiun .Numher
C
tgnate
\JJrwl..
— /t .hcicphonc
SEC ION F: WORKERS' CO NSATION INSURANCE AFFIDAVIT O. !.G.L. c. 152. § 2506))
Worko rs Compensation Insurance aftidavit must be uvnpletesl ;nd suhmitted with this apph,ao-m. F:inure iO ptu)1Je I
this at;,diivet will result in the dental of the Issuance of the building permit. _
Signed Affidavit Attached'? Yes .......... Cl No
SECTION 7a: OWNER AUTHORIZATION TO BE COMPLETED WHEN
ZWNEAGENT OR CO RACTOR APPLIES FOR BUILDING PERMIT
asOwnerofiha ,,,hj ci prnper;y hereby
__ __ _-_to act On my bchuif. inall mauus
o K authorize by thin bu ing per a ,cation.
wner Date
SECTION 7b: OWNER( OR AUTHORIZED AGENT DECL.ARATION
as Owner or Authoi zcd Agem hereby Jeciaic
that the statements and infixmation on the foregoing application are true and accurate, to the best of my kmtwicdge and i
behalf. ---
Print Name
Signature of Owner or Authorized Agent Date --
(Srmed under the pains and penalties ofper u )
Narss:
I. An Owner who obtains a building permit to do his/her own work, or an owner who hires an unre�ll,teled clHIW,Icu,r
(no( registered in the Hume Improvement Contractor (HIC) Program). will not have access to the :ubitranwi
program or guaranty fund under M.G.L. c. 142A. Other important infitrmaliun on the HIC Program an
Construction Supervisor Licensing (CSL)can be titund to 780 CMR Regulations I IO.R0 and I I0.145. respeco�ek,
When ,ubs(amial work is planned, pio%ide the in,trmanon below: _
Total flours area 1Sy. Ft.i (including garage, finished ba,ettien(lattte,, decks iir pOlchl
C'rntss living area Isy. Ft.) Habitable room count
Number Ot fireplaces Number M hedruom, _
I Number of h•uhownis Numberof
\pe of heating system — __-- Number Of Jcck,/ purthca
I ype Ol cooling system _ Fnvil„cd
}. "hued Project Square F001age" may he >ubstitu(ed for "folal Pnpec( Co,("