88 ALMEDA ST - BPA-10-569 The Cononomccalth of Massachusetts
y Board of Building Rqulations and Standards c t'.
NII'Vll ll'.\I.I II"
r Massachusetts State Building ('ode. 7SU('h1R, T'edition
t'.ti I'
Building Permit Application To Construct, Repair. Rcnocate Or I)enullish a irrl J haul• n
One- or Tun-Family Dit ellin,q %1\'
-- --
This S For O(ticial Use Only
Building Permit Number: Date pa"
Building vCommissioner/ upeaor of it ain Date ` ----- .
1
SEC '1,0 l: SITF. INFORMATION
LI Pr er v .Yddress 1.2 Assessors Map & Parcel Numbers
511�C S1Y p --
I.I a Is this an accepted stt eet?yes_ no Map Number Parcel �'un,ner
L3 Zoning information: 1.4 Property Dimensions:
Zoning District Proposed Use Lot Area(sq 111 Frontage(11)
1.5 Building Setbacks(ft)
Front Yard Side Yards Rear Yard
! Required Provided Rcyuired Provided Requited Pro%idcd
1.6 Water Supply: (M.G.L c.40, §54) 1.7 Flood Zone Information: 1.8 Sewage Disposal System:
disposal Zone: _ Outside Flood Zone:' - Municipal ❑ On site oral s stcnl ❑
Public❑ Private❑ Check if yes❑ P l
SECTION 2: PROPERTY OWNERSHIP[
o ner
115 i (lamI_ffY1ore IE AImpala- shrOL'
Name(PrirV I Address for Service:
9�)x �IUU- yp,�;)�1
Telephone
SECTIO : DESCRlPT10N OF PROPOSED WORK'(check at apply)
New Construction ❑ Existing Building ❑ Owner-Occupied ❑ Repairsls) Alteration(s) ❑ Addition ❑
Demolition ❑ Accessory Bldg. ❑ Number of Units Other ❑ Specify:
Brief Description o Pro used Work':
�JXDp j f- h o�i. �brltY acr Vor CiPSCriphirm
SECTION 4: ESTIMATED CONSTRUCTION COSTS
Item Estimated Costs: Official Use Only
(Labor and Materials)
f227,
. Building $ / q I. Building Permit Fee: $ Indicate hula tee is determined:
❑Standard City/Town Application Fee
Electrical $ ❑Total Project Cost'(Item 6) x multiplier x
Plumbing $ 2. Other Fees:Mechanical iHVAC) $ Lint: —
5. Mechanical (Fire ---
Su? ressi Total All Fees:
unl
$ � S
Check Na. Check :Amount ('nsh
6. Colal Project Cost: $ I 0 Paid in Full [IOutstanding Balance Due:-_—__--
SECTION 5: CONSTRUC•TION SERVICES
r
5.1 Licensed Cmtstructiun Supervisor(CSI.) 57?33
License Nuntbrr liy�uull Ifal.-
Nhntc of 'SI_- I to J•
I_ut C'SI_T%pe lane helm)
\ re . l v e Descri awn
C t'nreslncicd w,w 35.000('u. P1.1
R Rearmed 1&'_ F:unih DwrlLng
RC Residential ILndinc l'o,rung
Trlrphnnr WS Rc,uleuaal \Venda auJ S.Jmg _ '
SF Re,r&nlial Solid Purl Burning „h:mrr In.l.ilLw�ni
D Re,idenu:d Demolition
S.�t stead IIF tvlCp7vrment C n actor(IIICI .1b 10
HIC Cum ;in Nam r Hl •�irimu Name
IZC gI57ratll)n Number
9'lk �Ul _ou 2
F. ptratiur Date
5lenature Telephone
SECTION 6: WORKERS' COMPENSATION INSURANCE AFFIDAVIT(M.G.L.c. 152. § 25C(6))
Workers Compensation Insurance affidavit must be coTpjeed and submitted with this application. Fat lure to provide
this affidavit will result in the denial of the Issuanc the building permit.
Signed Affidavit Attached? Yes .......... Nu ........... ❑
SECTION 7a: OWNER AUTHORIZATION TO BE COMPLETED WHEN
OWNER'S AGENT OR CONTRACTOR APPLIES FOR BUILDING PERMIT
1. indtA �0056 flg 11b JfM 6Qom, as Owner of the subject property hereby
authorize to act on my behalf, in all ntatieis
relative to work authorized by thhii bu [din-permit application. .
nature IOwn Date
SECTION 7b: OWNEW OR AUTHORIZED AGENT DECLARATION
I, as Owner or Authorized Agent hereby dechae
that the statements and information on the foreguit application are true and accurate, to the best of my knowledge and
beh
Print N YA
e
Sign au of 6wrier or Authorized Agent Date -
(Siened under the pains and penalties of perjury)
NOTES:
I. An Owner who obtains a building permit to do his/her own work, or an owner who hires in unregistered contractor
(nut registered in the Hume Improvement Contractor(HIC) Program), will not ha,'e access to the it
program or guaranty fund under M.G.L. c. 1.12A. Other important information on the HIC Pmerun:nd
Construction Supervisor Licensing(CSL)can be found in 780 CMR Regulations I IO.R6 and 110.115. respectively.
?. When substantial work is planned, provide the information below:
Total floors area(Sq. Ft.) (Including garage, finished base men t/att ics, decks or porch) -
I Gross living area ISq. Ft.) -Habitable loom count
Number of fireplaces Number of hedroum,
Number of bathrooms Number of halt/hash,
rvpe of heating system Number of Jeek,/porches
Type of cooling system Fncln,ed _Open --
3. "Total Project Square Footage• tnay be substituted for"Total Project Coat"