7 HODGES CT - BPA-13-400 INTERIOR WORK t
c
C1� S�1 �10 � � 0
_ L --- I'ht C'unmw11wCAIh of Massathusells
Board of Building Regulations and Standards CITY DF
SLISsachuSttls Statc Building Cod,, M CAIR
BIIIIJIIIg Porn tit Applirniun TO Construct. Repair. IZCItUV;lte Or Dl`IItUh5h a
Onv-ur Tlrn-Panull' Du vllin,\p
ThiS Section For Otli al Use Onl
Building Permit Nwnber: D Applied:
I1"IidInT)11,1aI(Print Nmne)
Sigsta re Dale
L I Properly AJJr SECTION 1:SITE INF RAIA
esa'DGI�S C Oc It 1.2 Asse ora Slap di Parcel Numbers
— 7 )K
I.lab this ar aca ted street? to no Mup Nunthvr +
I urcel Number
1,3 Zoning Information: Li Property Dimensions;
Luring DiSlncl I'n�pnscd lJ—ry Lm An:v(S II)
4 Pmmuga(Il)
I.! Building Setbacks(R)
FromY:vd Sid v Yurda
Reyttired Provided RequiredPravidvd
Rryuired Rvar YardI+ruviJed
1.6 Water Supply:(M.G.I.v. 40, §34) 1.7 Flood Zont Information;
Rt611c O Pritaty O
Zone: _ GutsiJo FloodLuno? I.S Sewaye Dlaposal System:
Cheek ifaO Munieipd O Dn ilto disposal s)stem O
SECTION I: PROPERTYOWNERSHIPr
25�Ownert�fcordr 'G
�I,unu(Pnm) C tt).Salta,L.IP
Nu.and Street
rvlephone Elnail AJdrcsa
SECTION J: DESCRIPTION OF PROPOSED WORK'(check all that apply)
New Construction❑ Existing 8uildiny❑ Owner•Occupied ❑ Repoin(a) O Alteratlon(s) Cl Addition O
Demolition ❑ Accessory Bldg. ❑ Number of Units
Brief Description of Proposed Work': Other ❑ .Spevi ty:
SECTION 4: ESTISI.ATED CONSTRUCTION COSTS
Ilettt Estimated Costs:
I Labor and\laterials) 0mclal Use Only
I. Building S L Building Permit Fee: S Indicate how fee is determined:
'. i[icclrical S O Standard Ciry:Town application Fee
I J I'hunhing S ❑Tom) project COst'l Item 6).x multiplier .x
t. Ulher Fees: S_
J. \ICCh.utical ill\ \C) j List:
\lei h.wic.111Fne ._ ..--_�—_—_.___ _..
�u vC>iiunl S f,aal \II FCef:
n Total Project Cult S u0 rJ r� C11"k Vo. _. . _( htcA .\nnnurt: . _. .- , .C.tih \nenum:
( �Vl O P.IiJ m Full 13 I)ulstvlding llal,mte Out::
SE('I'IUN S: ('1)NSl'RIiC'flON tiF.H�'I('ES
t,l 'unstructiunSupcniiorLicenie(CSI.I
I Icen�c Nunlhcr
Nal to oRfrxC 11,kl c- ' Q' )fS 9 I I'l C'sI. f)pc('cc -
q, i)cicriplion
Nu, midstrcd -� ----- (I l�nreitridcJ(Ilu1lJinetitolS,000al. l .l
It KatridcJ I:h-' f.unil Dndlin
C'in)lrmw.Stake.Lll' KC 14,11011111Clncrin
µS µ'indun',old Sidi"
•— tip Solid Ivul Iluminy %pplianceii
I Ilnlllutllln
I'dc bona
— hmail addre.i
D Deaudiliun
�,2 Registered Ilume Improvement Contractor(HIC) IIIC'Itcglatralion Number li�pirulinn Wttt
IIIC 01111 pall) ti le or IIIC Itagistrunt Ill
Email uJJresa
Nu. and Street —�
roc hone
Ci frown,State ZIP
ATION INSURANCE AFFIDAVIT(M.G.L e. 131. 1 2SC( )
SECTION 6:WORKERS'COMPENS
Workers Compensation Insurance affidavit must be campieted and submitted with this application. Failure to provide
this affidavit will result in the denial of the Issuae of the building permit.
nc
Signed Affidavit Attached? Yes .......... O
No...........(]
SECTION 7s:OWNER AUTHORIZATION TO BE COItIPLETE0 NV
HEN
OWNER'S AGENT OR CONTRACTOR APPLIES FOR BUILDING PERMIT
1, as Owner of the subject property,hereby authorize
to act on my behalf,in all motten relative to work authorized by this building permit application.
Outa
Print Utsucr's Nwne(Electronic Signuturv)
' OR AUTFIORIZED AGENT DECLARATION
SECTION 7b:OWNER
By entering my name below, I hereby attest under the pains and penalties of perjury that all of the information
not i ed in this applic lion is true and accurate to the best of my knowledge and understanding. I
Data
tutcrsur:\uthorvcJ,\yul '. , unw(Ifl drunicSiynauua)
VOTES:
(nutregistered in thetHun a hnpruvenentt nit tCo�mctor(H10 Programl.his her awn %�ork. n ilinn r ct shave access to the ariles an bitration
program ur guar:uuy I'wid under M.G.L.C. 1 a_2A. Other important information on the HIC Program can be Ibund at
Information on the Construction Supen�isor License can be found m tt tl" �II't" 'mil l 'IIt�
\\hen substantial twrk is planned• infurnlntiun below:
I including garage. IinishrJ basement attics. Jerks or porelu
rota) (lour area 1 ay. tf.l - ----"— Habilahle rumn count
Uroiili%ing 'ilea lsy. 1l.t ._. _... . .. \unlhcrofbcdrolnui
♦kill lhcrol'lircplaws .. ... _ \untbcrol'hollh;uhs
\unthcr,tl'hadvowtts , . \'unlhcrol'Jccki- ptlnhcs
I t pc tll'hc.ltotg i),Icm 1,116"cd ,(then
1 ,
1 ..r,�lal i'ngcd Squ;ve httelgc"mas h¢ .uh.GlutcJ Illr 'rto.il Prated C 1,C