13 CARLTON ST - BUILDING JACKET r
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` The Coninionvkealth Ot Massachusetts
Board of Building Regulations and Standards FOR
Oy ,i, %it Nk II'.\LI I1
t.' 9 Massachusetts State Building Code. 730 CMR. 7 edition tilt
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`.r.•' B 'tsiJ.l�Inmrr:. �
uilding 1'Lrmit Application To Construct. Repair. Relics Or Denn Rt't
tlish a I
... ' \ /.
One- or Tiro-Fmnrh Drrr11)t,q
This Sec ion Fur-Otticial se Only
1 Building Permit Nun er a A lied:
\ Signature: 1 8 --- —
BuildingC011I111INN1011i- Inspector of Build ig. Date
SECTION SITE INFORMATION
1.1 Pr( 1.2 Assessors Map S Purcel Numbers
�la Is this in accepted street? yes-.__ nu_ Map Number P:ucrl Nwnnci
1.3 Zoning Information: 1.4 Property Dimensions:
Zorang District Proposed Use Lot Area lay f) Frontage tit) --
1.5 Building Setbacks(ft)
Front Yard Side Yards Rear Yard ---
i---. ---1
! Reu{uird Provided Required Provided Required Pw<iu:�i
-J
'-
- -----
1.6 Water I L 1V Supply: (M.QL c.40. §54) 1.7 flood Zone Information: LS Sewage Disposal System:
Zone: _ _ Outside Flood Zone'
Public ❑ Private❑ Check it yes❑ Municipal ❑ On site dislrsal syaem ❑-
SECTION 2: PROPERTY OWNERSHIP[ i
C2.] OwnertofRecord: � 3 CFI �,LTo-si �'1' _
�i�nlC iPru;U Address for Service:
Srvnau: e Telephone
SECTION 3: DESCRIPTION OF PROPOSED WORK'(check all that apply)
New CouStraCipp ❑ I Exiting Bt,ildin �wner-Occupied Repairs(s sltera1ion(d) ❑ Addition ❑ ,
fDemolition ❑ Accessory Bldg. ❑ Number of Units_ J.Other ❑ Specify:__
--
?rietGes-1ip"on of Proposed Work :_ -----------
I
-i
SECTION 4: ESTIMATED CONSTRUCTION COSTS i
j Item Estimated Cows: Official Use Only
(Labor and Ma(erials)
t -
t Building $ 1. Building Permit Fee: $ _ Indicate how tee is de(Cnun<d: 1
❑ Standard City/Town Application Fee
2. Electrical $ ❑Total Project Cost' (Item 6) x multiplier x _
3. Plumbing $ 2. Other Fees: $
- - I
J. Mechanical (HVAC) $ List: -- i
5. Mechanical (Fire $ Total All Fees: $
Su ression)
T7 Check No. Chick :\mount C;uh \mount: .- i
j 6. 'total Project Cost: 3 8a 0o$ r ❑ Paid to Full 0 Outstanding Balance Due:__-_
SECTION 5: CONSTRUCTION SERVICES
5.1 Licensed Construction Supervisor(CSI.)
License Number Ispuauon Dale
Namc of CSl_- Holder }� -
1 y q M.41� eJ T'!�`P,4 6n 9y List C'S I_'fypc(see hclutcl
4ddre Tv c m35,000
Deslion a
UcstnueJ lu m (I(IO0(('u ii, . I=t.r
R Restricted 1,V 2 Fanuly DOelhnfl
swilalnre .fit Nlasonry Only
j RC Residential Rootine t'userme
Telephone 11'S I< -drnual Wmdutc and Sid_me
11 11Slr Rrsidenti'd Solid Fuel 8urnina \ t thane. Ins Lillawu
U Re,idential Demolition
5.2 Registered ,,&:Improvement Contractor(HIC) O O 8 `
HIC Cons any Nmne ur HIC Registrant Na Regutrutun Numhcr
9 �+ a M 4 6n=- , 2 3- 1a
Add Expiration Uutc
Signature Telephone j I
SECTION 6: WORKERS' COMPENSATION INSURANCE AFFIDAVIT(M.G.L. c. 152.§ 2506)) 1
—7
Workers Compensation Insurance affidavit must be completed and su`mitted with this application. Failure lu provide j
this aftidar:t will result in the denial of the Issuance of the building permit. j
Signed Aftida,.;z Attached? Yes .......... 0 No .._....... ❑
SECTION 7a: OWNER AUTHORIZATION TO BE COMPLETED WHEN
OWNEWS AGENT OR CONTRACTOR APPLIES FOP. BUILDING PERMIT
1, as Owner of the subject property hereby
authorize —___— _ _to actun my behalf, in all ma!ter.,
relative to tvjrk authorized by this b..iidtng pc'imit application.
I '
Si mrlur of Owrcr Date
SECTION 7b: OWNER) OR AUT"ORIZED AGENT DECLARATION
r
/ I
L 4,..�y�✓ �l( �m-e+: , as Owner or uthoi•ize Agen hereby Declare
that the statements anti information tin the foregoing application are true and accurate, to the best, or my knowledge at.d I
behalf.
Print Name
Signature of Owner or -e 'A et Date
(Signed under the pains and penalties of perjury)
NOTES:
1. An Owner who obtains 1.1 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 not have access to the arbitration
program or guaranty fund under M.G.L. c. 142A. Other important information on the HIC Program and
Construction Supervisor Licensing (CSL) can be found in 780 CMR Regulations I IO.R6 and I MRS. respectively.
' When substantial work is planned, provide the information below:
Total flours area (Sq. Ft.I (including garage, finished base mentlatt ics,decks or porch)
Gross living area (Sq. Ft.) Habitable room count _
Number of fireplaces _ Number of bedrooms _
Number of hathruums Number of half/baths
'type of heating system Number of decks/porches
'Type of cooling system L-nelosed Open --
3. "Total Project Square Footage- may be substituted for "Total Project Cost"
EI TStOF�xI.Ei�
PUBLIC PROPERTY
DEPARTME,�T
u-MMALE r DRWA L
MAYOR
i30wASHD0r"* "1tr= 1m-M..MMAaH:s!•rmot97o
Tou M?4s 9S9S•FAtc 97r•710.96K
APPLICATION FOR THE MAUL NG RENOVATION CONSTRUCTION
DEMOLITION, �R CHAE OF USE OR OCMrP�wr
STRUCTL� . � FOR ANY EXISTIlV['
OR BUILDnvr
1.0 SITE INFORMATION
Location N building
prop"
Property Ie`located in a:Conservatlon Area YM HkvWM Okttrict YIN
2.0 OWNERSHIP INFOR TION
2.1 Owner of Land S'
Name:
Address:
Telephone:
Eyearof
TE THIS SECTION FOR WORK IN RyliazINp BUILDINGS ONLY
/GExisting
Number of Stories Renovated
e New
Existing
year of Area per floor (30 Renovated
construction or renovation
of existing building [1� vl New
Ebief Description of Proposed Work-
-- Mail Permit to:
What is the current Use Of uildi ? H ctwe1Rng.how many
Material of Building? Asbestos? U
Wip the Building Contort,to Law?
Amhiteds Name ( 1
Addross and Phone <
Mechanic's NAddress ames
and �- —� �c/fi /F
Constn+dion ��License HtC Registration
Su
Estimated Cost o!Project ` Permit Fee Calailation
3 3 . Estimated Cost X S7IS1000 Residential
Permit Fee S - Estimated cost X S11141100O Commereia� ----
- - An Additional$5.00 is added as an
Administrative charge.
Make sure that all fields are properly and legibly written to avoid delays in processing.
The undersigned does
hereby apply for a Building Permit to to the above sta
specificatlons. Signed under penalty of perjury
Date
i
N
s �
— � .a— — —
X� The Commonwealth of Massachusetts CITY OF
1 Board of Building Regulations and Standards CITY
0 / } Massachusetts State Building Code,780 CMR Revised b)ur 2011
\ Building Permit Application To Construct, Repair, Renovate Or Demolish a
One-or Two-Family Dwelling
This Section For Official Use Only
Building Permit Number: Date ppliedi
Building otiicial(Print Name). Signature- Dat
SECTION 1:SITE INFORNIATIOfW
1.1 Property r t3 ss: �' 1.2 Assessors Ninp&Parcel Numbers
[.!a Is this an acce ted street?yes_jve:� no Map Number Parcel Number
1.3 Toning Information: 1.4 Property Dimensions:
Zoning District Proposed Use Lot A;a(sq 11) Frontage(11)
1.5 Building Setbacks(R)
Front Yard Side Yards Rear Yard
Required Provided Required Provided Required Provided
1.6 Water Supply:(M.G.L e.40,§54) 1.7 Flood Zone Information: 1.8 Sewage Disposal System:
Public❑ Private❑ Zone: _ Outside Flood Zone? Municipal❑ On site disposal system ❑
Check if yes13
SpECTION2. PROPERTY OWNERSHIP!`
t��me(�� city,state,ZIP �0
--'iNu.an Stred + 'telephone Email Address
SECTION 3: DESCRIPTION OF PROPOSED WORK'(check all that apply)
New Construction❑ Existing Building)d Owner-Occupied ❑ Repai ❑ 1 Addition ❑
Demolition ❑ Accessory Bldg.❑ Number of Units_ Other ❑ Specify:
Brief Desc 'ptio t of Pro osed Work=:-
/ CKC OdI
O Al
��t
le r ( �N/ i
SECTION a: ESTINIAT96CONSTRUCTION COSTS
Item Estimated Costs: Official Use Only
Labor and Materials)
�0 1. Building S (eQ I. Building Permit Fee:$ Indicate how fee is determined:
❑Standard City/Town Application Fee
2. Electrical S ❑Total Project Cost?(item 6)x multiplier x
3. Plumbing $ ''P,9therFees: S
4.Mcchanical (HVAC) $ - List:
5. Mechanical (Fire $ Total All Fees:$
Su ression)
r 'Check No._Check Amount: Cash Amount:_
6. Total Project Cost: •'S 7 G t�Q Cl Paid in Full ❑Outstanding Balance Due:
t�Gi '/'0
SECTIONS: CONSTRUCTION SERVICES
5.1 Cur)tructionSupervisur rcense(CSL) CS /00S(ox
.Q v 1,f License Number Expiration Date
N;une of CSL Holder List CSL'rype(see below)
No.and et Type - Description
GL� 00G l� U Unrestricted(Buildings no to 35,000 cu. 11.
R Restricted 1&2 Family Dwelling
Citylrown,State,ZIP M Masonry
per, RC Rooting Covering
WS Window and Siding
,7- SF Solid Fuel Burning Appliances
�0� I Insulation
Telephone — Email address D Demolition
5.2 Rc istered Home lnyArovem�enntt Contractor(11IC) ...�5'D 6-7
i 0 (Da ( } 1— ( HIC Registration Number Expiration Date
IIIC Comp Name or flit Regiylr.+nl Name
No. and Street �1 p-7.,, Email address
Ci[ /rown State ZIP Telephone 7 (�
SECTION 6:WORKERS,COMPENSATION INSURANCE AFFIDAVIT(M.G.L.c.152.g 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 Is§uance of the building permit.
Signed Affidavit Attached? Yes ......... No...........❑
SECTION 7ac OWNER AUTHORIZATION TO BE COMPLETED.WHEN
OWNER'S AGENT OR CONTRACTOR APPLIES FOR BUILDING PERMIT
I,as Owner of the subject property,hereby authorize
t9 act on my behalf,in all maatttteers�s relative to wpllrk authorized by this building permit application. fY/1
Print Owners Name(Electronic Signature) Dale
SECTION 7b:OWNERI 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.
Print Owner's or Authorizcd Agent's Name(Electronic Signature) 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 Improvement Contractor(HIC) Program),will not have access to the nrbitration
program or guaranty fund under bI.G.L.c. I42A.Other important information on the HIC Program can be found at
tvww.nuass. rot, �0 Information on the Construction Supervisor License can be found at www.massaoLIM
2. When substantial work is planned,provide the information below:
'total floor area(sq. tI.) '� _,(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. "from Project Square Footage"may be substituted for"'focal Project Cost"