0023 TURNER STREET - BPA 10-383 �j�14V �9
1J The Commonwealth of Massachusetts Town of
►� Board of Budding Regulations and Standards
Massachusctts State Building Code. 780 CMR. T"edition
Building Dept
Building Permit Application To Construct. Repair. Renovate Or Demolish a dims&
One. or Too-Furnih Duelling
^ This Section For Official Use Only
Building Permit N b/eJe Date Applied:
Signature: ////'�/.7�
Building omrnission6rkfnspectorofOuildinp Date
SECTION 1:SITE INFORMATION
1.1 Property Address: 1.2 Assessors Map& Parcel Numbers
I.1 a Is this an accc led street?yes no Map Number Parcel Number Ili
1.3 Zoning Information: 1.4 Property Dimensions:
Zoning District Proposed Use La Area(sq fl) Frontage(it)
1.5 Building Setbacks(it)
Front Yud Side Yards Rear Yard
Required Provided Required Provided Required Provided
1.6 Water Supply:(M.G.L c. 40,15a) 1.7 Flood Zone Information: 1.8 Sewage Disposal System:
Zola: _ Outside Flood Zone? Munici al O On site disposal s stem O
Public O Private O Check if s13 p Y
SECTION 2: PROPERTY OWNERSHIP'
2.1 SO��1t^(woer'of Reeord:
co B,,.d�l� - — �o U 7T�Y �'t
Name(Print) Address for Service:
L��g� r��n L ���
Signature Telep one
SECTION l: DESCRIPTION OF PROPOSED WORK'(cheek.all that apply)
New Construction O Existing Building ClOwner-Occupied O Repairt(s) Alterations) O Addition O
Demolition O Accessory Bldg. O Number of Units_ I Other O Specify:
Brief Description of Proposed Work:
SECTION 4: ESTIMATED CONSTRUCTION COSTS
Item Estimated Costs: ORklal Use Only
Labor and Materials
I. Building f I. Building Permit Fee: f Indicate how fee is determined:
O Standard City/Town Application Fee
2 Electrical f O Total Project Cost(Item 6)s multiplier s
) Plumbing f 1. Other Fees: f
J. .Mechanical IHVAC) f List:
t 4echanical (Fire f Total All Fees: f
Su ression
�j Check Vo. _Check Amount: Cash Amount:
ts Total Project Cost: f �� 0 Paid in Full 0 Outstanding Balance Due:
SECTIONS: CONSTRUCTION SERVICES
!.I Licensed Construction Supersisor(CS::;
S I ( 0
�i± j � x Number Esp rail n Date
N ofC Ilvlder 1�F71.1A/ SL TnaYpe lu-r IRluwl Descri tion
rss Unrestricted u to 35,000 Cu. Ft Restricted 182 Famd DwelhnSignature � Mason Only
7�J o RC Residential floating Covering
Telephone WS Residential Window and Siding
SF Residential Solid Fuel Burning Appliance Installation
D Residential Demolition
5.2 eglstered Home at Contractor(HIC)
HIC Comp Name or HIC Repstiant N RegistrNumbrr
sut�.jelelc r car MW13rA-5 luA a
A ai o �tp -- apira on Date
Signature u Telephone
SECTION 6:WORKERS'COMPENSATION INSURANCE AFFIDAVIT(M.G.L.c. I52.1 2SC(6))
Worker Compensation Insurance affidavit must be completed and submitted with this application. Failure to provide
this a0id ivit will result in the denial of the Issuance of the building permit.
Signal Affidavit Attached? Yes.......... d No........... O
SECTION 7a:OWNER AUTHORIZATION TO BE COMPLETED WHEN
OWNER'S AGENT OR CONTRACTOR APPLIES FOR BUILDING PERMIT
I as Owner of the subject property hereby
authorize to act on my behalf,in all matters
relative to work authorized by this building permit application.
Signature of Owner Date
SECTIO(NN77b:O,WNERt OR AUTHORIZED AGENT DECLARATION
I, 1 J� ,as Owner or Authorized Agent hereby declare
that the star— ement and information on the foregoing application are true and accurate, to the best of my knowledge and
behalf.
Print Name
Signature of Owner disAuthorized Agent Date
Si red under the point and penalties of perjury
NOTES:
I. 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 r&have access to the arbitration
program or guaranty fund under M.G.L. c. I42A. Other important information on the HIC Program and
Construction Supervisor Licensing(CSL)can be found in 780 CMR Regulations I I0.R6 and I I0.R3. respectively.
I. When substantial work is planned,provide the information below:
Total floors area(Sq. R.) (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 halfbaihs
Type of holing system Number of decks/porches
Ts fit of cooling system Enclosed Open
1 Total Project S4uare Footage"may he substituted for 'Total Project Cost"