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B-17-665 - 0017 BERTUCCIO AVENUE - Building Permit mac` The Commonwealth of Massachusetts Board of Building Regulations and Standards CITY OF Massachusetts State Building Code,780 CMIN11 XlL } 8 { : 1,;I�,LEM `_nn Revised Mar 2011 V J Building Permit Application To Construct,Repair,Renovate Or Demolish a One-or Two-Family Dwelling This Section ForOfficial Use Only ` Building Permit Number: Dat Applied: Building Official(Print Name) Signature Date. SECTION 1:SITE INFORMATION 1.1 Pro arty Address: �1 1.2 Assessors Map&Parcel Numbers { L C1 L l a Is this an accepted street?yes no Map Number Parcel Number 1.3 Zoning Information: 1.4 Property Dimensions: Zoning District Proposed Use Lot Area(sq ft) Frontage(ft) 1.5 Building Setbacks(ft) Front 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: Public❑ Private❑ Zone: _ Outside Flood Zone? Municipal❑ On site disposal system ❑ Check if yes❑ SECTION 2: ''PROPERTY OWNERSHIP' 2.1 Oy ner'of Record: udte.y iA P 5atevn , 9A 619T0 Name(Print) �— City,State,ZIF _ 11 t9VC No.and Street Telephone Email Address SECTION 3:DESCRIPTION OF PROPOSED WORKZ(check all that apply) New Construction❑ Existing Building❑ Owner-Occupied ❑ Repairs(s) ❑ Alteration(s) Addition ❑ Demolition ❑ Accessory Bldg. ❑ Number of Units Other ❑ Specify: Brief Description of ProposedWork2: ffy eQl y► G1V1CI_ ��Q`{[nPrt2Cl �flbh �Q—C^►n sad e SECTION 4 ESTIMATED CONSTRUCTION COSTS Item Estimated Costs: Official Use Only Labor and Materials 1.Building $ f L Building Permit.Fee:$ Indicate how fee is determined: 3 S ❑Standard City/Town Application Fee 2.Electrical $ ❑Total Project Costa,(Item 6),x multiplier x. 3.Plumbing $ 2. Other Fees: $ 4.Mechanical (HVAC) $ List: 5.Mechanical (Fire $ Suppression) Total All Fees:$ II Check No. Check Amount: Cash Amount: I 6.'Total Project Cost: $ 4 1� 0 Paid in Full ❑Outstanding Balance Due: SECTION 5: CONSTRUCTION SERVICES 5.1 Construction Supervisor License(CSL) 03 g3« License Number Expiration Date Name of CSL Holder List CSL Type(see below) No.and Street Type Description 8ostoy) �]p U Unrestricted(Buildings u to 35,000 cu.ft.) �"I rr of T R Restricted 1&2 FamilyDwelling City/Town,State,ZIP M Masonry RC Roofing Covering WS Window and Siding .3p 6-- 3311 SF Solid Fuel Burning Appliances _ I Insulation Telephone Email address D Demolition 5.2 Registered Home Improvement Contractor(HIC) _ o nef ig11 3� 3 � 1 � Q �� HIC Registration Number Expiration Date HIC Company ame or HIC Registrant Name _ 101 gtatioalc�{2i 9 No.anted Ed(A' MA ©a Email address M Cit. /Town,State,ZIP Telephone SECTION 6:WORKERS'COMPENSATION INSURANCE AFFIDAVIT(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...........❑ 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. Print Owner's Name(Electronic Signature) Date SECTION 7b: OWNER'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. Joe [hnovan TV/I Print Owner's or Authorized Agent's Name(Electro is 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 arbitration program or guaranty fund under M.G.L.c. 142A.Other important information on the HIC Program can be found at www.mass. og v/oca Information on the Construction Supervisor License can be found at www.mass.g_ov/dpss 2. When substantial work is planned,provide the information below: Total floor 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"may be substituted for"Total Project Cost" PLAN VIEW Name: G -e Site ID: 505 j Zq,�& Ygprs in HgMq; / Phone: Year of House: Electric Acct#: 75&7-5—k&00 Addrl ss� ((i n #of Floors: ( Gas Acct#: a • (U� #Occupants: Fuel Costs: Interested in Solar?Y/N Interested in Windows?Y #of Sin 12 Pan2 Known Knob and Tube?Y Nat Sups Ho Cold areas in home?Y N Where? Major Renovations? Icicles ice Damming?Y N Where? Moisture issues? Other C6ncerns? HEATING SYSTEM AND HOT WATER ; Furnace Boiler Age: Last Service: Efficiency: 107 Notes: - - DHW:Storage/Indirect/Tankless Coil/On demand DHW Age: Gas:Home/Street/None —- - _— - Bsmt: 'x x BASEMENT INSPECTION i CS: x x Existing Sec ing Ln/Sq.Ft. _ _ —_ _ Bsmt Rim Joist Bsmt Wall(AG) - - - —Crawl Ceiling — Crawl Rim Joist Vapor Barrier ! 5. Bsmt Door:'::',. •�---- K v - q Y N Blower Door? WALLS&GARAGE Drill Locations: Siding Cell.Hei ht Existing Speeing S .Ft. Framin Exterior=Wall? n x x Balloon/Platform Exterior-Wall2 x x Balloon Platform Overhang x x Garage Wall x x Balloon/Platform Garage Ceiling x x Meta Lathe I ; i A'S i I : : weeds , I ; i Crew N®tes: I ,�,. ROAD BLOCKS Asbestos Y/ O Vermiculite Y Moisture Y Mil Mold 100s ft Y tructural Y HO(�1eW01ICS CST Y Energy,Inc CO Detector Y i KW WALL AND KW FLOOR OR KW SLOPE AND GABLE END' Why? Wh ? FRAMING . EXSTING SPFC'ING S s s`; �l PRIMING EXISTING SPEG'ING S .FT WALL X X ;: g .: X X X x L .�, 1 FLOOR .' GABLE X X ACCESS X s t TRANS X X ` a orb . RANS X c;r,lnc ATTIC4t t ._ MW ATTIC z SLOPE X XSLOPE XX EXISTING VENTING? Ir ENTING? EXISTING PIPES? Y/N PES? 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