19 BARCELONA AVENUE - BUILDING JACKET 19 Barcelona Ave.
E�,r;O\14y,
f. R
(fitg of `ittlem, fflassar4uteetts
lepartntrut of jJublir parks
(one 1111�alem (green
ANTHONY V. FLETCHER, R.P.E. RICHARD P. SWENSON, C.E.
DIRECTOR of PUBLIC SERVICES Assistant Civil Engineer
CIN ENGINEER
August 22, 1979
TO: JOHN POWERS
BUILDING INSPECTOR
FROM: A. V. FLETCHER
SUBJECT: KAREN DiANTONIO
t19BA LECR ONA AVENUEYFLYNN LEATHER
Mr. & Mrs. K. DiAntonio, 19 Barcelona Avenue, have received from you a foundation
permit. Sewer construction has advanced enough so that I can authorize a sewer permit.
If there are no other obstacles, you may release the building permit.
FLYNN LEATHER:
Support system for "staking" machinery appears adequate, though I recommend
instalation of vibro-isolators at polishing machine.
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The Commonwealth of Massachusetts
OF
Board of Building Regulations and Standards CITY M
WE Massachusetts State Building Code, 780 CbIR SdMar
Revised Mar 2011
Building Permit Application To Construct, Repair, Renovate Or Demolish a
One-or Two-Family Divelling
This Section ForOfficial Use Only
Building Permit Number Date App ied-j
'.n
Building Official(Pnnt Name) Dae
t g -
SECTION 1 SITE I FORMATION
1.I Property Address: 1.2 Assessors Map& Parcel Numbers
C4�U.
q Ma Number Parcel Number
t s no P
l.1 a Is this an accepted street? e
P Y
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.01 c.40,§54) 1.7 Flood Zone Information: 1.8 Sewage Disposal System:
Zone: _ Outside Flood Zone?
Municipal❑ Private❑ unicipal❑ On site disposal system ❑
Check if yes❑
SECTION PROPERTYOWNERSHIPi"
2 1 wnert of Record:
Name(Print) City,State,ZIP
No. and Street Telephone Email Address
SECTION 3: DESCRIPTION OF.PROPOSED WORK'(check all that apply)
New Construction ❑ Existing Building ❑ Owner-Occupied ❑ Repairs(s I Alteration(s) ❑ Addition ❑
Demolition ❑ Accessory Bldg. ❑ Number of Units_ I Other ❑ Specify:
Brief Description of Proposed Work':
SECTION 4: ESTIMATED CONSTRUCTION COSTS
Estimated Costs:
Item Official Use Only
Labor and Materials
1. Building $ I Building PermitFee $ Indicate how fee is determined:
❑ Standard City/Town Application Fee
2. Electrical S
❑'total Project Cost',(Item 6)x multiplier x /( f
3. Plumbing 5 2. OtherFaes: $ � V
4. Mechanical (HVAC) S List:
5. Mechanical (Fire $
Sii: r4 p ession) Total All Fees: S
Check No. Check Amount: Cash A nounti
6. Total Project Cost: S (0) W ❑ Paid in Full ❑ Outstanding Balance Due:
"czcQ k
SECTION 5: CONSTRUCTION SERVICES
5.1 Construction Supervisor License(CSL) `o
License Number pi J
�—� Esntion Date
ame of CSL holder
/�,�^.) List CSL Type(see below)
N
� Type Description
No. and Street
I'- U Unrestricted Duildin s u2 to 35,000 cu. ft.
��—(^��P R Restricted 1&2 FamilyDwelling
City/ own,State, "LIPS --� bl Nlasonr
RC Rooting Covering
WS Window and Siding
SF Solid Fuel Darning Appliances
[ i Insulation
"rele hone Email address D I Demolition
5.2 Registered Horne m m proveenl Gontr'tctt/R (f�[C I ) rRe
�\r YY�)''ee_ \SC /`C�Q)%c5�C/`� � MC Registration Number Expiration Date
TI omp ny Naippe or I-TIC R•gis rant Name �-
N ndStreet �` � �,—!.><.J Email address
Ci /Town, State, Z P V\ 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 ..........\bJ No ...........
El
SECTION 7a: OWNER AUTHORIZATION TO BE COMPLETED WHEN
OWNER'S AGENT OR CONTRACTOR APPLIES FOR BUILfDING PERMIT
[, as Owner of the subject property, hereby authorize CC L�C�C� I l�
to act on my behalf, in all matters
matters relative to work authorized by this building permit applicat�io7n.
P nt 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. `
Tint�ncrsoruthorized.Agents Name(Electronic Signature) Date
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 Honie Improvement Contractor(HIC) Program), will not have access to the arbitration
program or guaranty find under NLG.L. c. 142A. Other important information on the 1IIC Program can be found at
www.tu:ss <lov oca Information on the Construction Supervisor License can be found at www.mass._o�:dL
2. When substantial work is planned, provide the information below:
Total floor area(sq. 11.) _(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
I'ypeofcooling.sylem --__-- Enclosed_ --
). -Total ProjectSqu,u"u Footage" way be substitutod for"Total Project Cost" j(� .
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