The URL can be used to link to this page

0024 ARBELLA STREET - BPA-14-1701 ROOF T�- i �t- too ( The Commonwealth of Massachusetts �VE�IT Board of Building Regulations and Standards R`Q Massachusetts State Building Code, 780 CMR Revised A1ar2011 q Building Permit Application To Construct, Repair, Renovate Or Dernil4isOhCt •' A } One-or Two-Family Dwelling4. n. This Section For Official Use Only Building Permit Number: Date. piled: Duilding Otlicial(Print Nnme). - _. Signature - . Date \ SECTION 1:SITE INFORiNIATION 1a 1.1 Property Address: t A j / 1.2 Assessors Map& Parcel Numbers 1.1 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 11) Frontage(11) 1.5 Building Setbacks(R) Front Yard Side Yams Rear Yard Required Provided Required Provided Required Provided 1.6 Water Supply:(M.G.L c.do,§54) 1.7 Flood Zone Information: 1.8 Sewage Disposal System: Zone: _ Outside Flood Zone? Municipal [3 On site disposal system ❑ Public❑ Private❑ Check if yesE3 SECTION 2: PROPERTY OWNERS/HIP,' 2. wnerl of Record: {t, /om /� �^ e- me( Zd r Print) Ci2 St;j ZIP ' - � L� 5 No. and Strect Telephone Email Address SECTION 3: DESCRIPTION OF PROPOSED WORK'(cheek all that apply) New Construction❑ Existing Building❑ Owner-Occupied ❑ Repairs(s) ❑ Alteration(s) ❑ Addition ❑ Demolition ❑ Accessory Bldg.O Number of Units_ Other ❑ Specify: Brie'Descrip 'on ofProposed Work': 0 r SECTION a: ESTIMATED CONSTRUCTION COSTS Estimated Costs: Official Use Only Item Labor and Materials 1. Building S I. Building Permit Fee:S Indicate how fee is determined: ❑Standard City/Town Application Fee 2. Electrical S ❑Total Project Costa(Item 6)x multiplier x 3. Plumbing S 2?Other Fees: Sj 0 Lt. NIcehanical (FIVAC) S List: 2 >, Mechanical (Fire Total All Fees:S Su ression) ,rr ro Check No._Check Amount: Cash Amount: 6. Total Project Cost: S 7 �j ❑Paid in Full ❑Outstanding Balance Due: T -r0 co p PS o(-,5, SECTION 5: CONS,rRUCTION SERVICES 5.1 C„nstruction, t�isor License(CSL) (y. e License Number Expiration Date Ndme o L alder,' • .�,� List CSL Type(see below) l ©6 Type � Description No. and S et \/�' y a l� ( � U RcstriUnrestdoted& BuiWin s u -toing cu. Il. R Restricted I&2 Fmni1 Uwellin City/rmvn,Slate,ZIP M Masonry RC Rooting Covering WS Window and Siding SF Solid Fuel Burning Appliances 1 Insulation Tole hone Email address D Demolition 5.2 It ist ed Home(J�mprovepment Contractor(HIC) T~ V�fiV f<<'L-0 HIC Registration Number Expiration Date HIC Cuntpan Lime or Hf� egistral)t ran Gt / � No. and Street ' n �j -7 O Email address City/Town,State ZIP C/ ` ( Telephone SECTION 6:WORKERS'CONIPENSAT[ON INSURANCE AFFIDAVIT(M.G.L.c. 152.4 25C(6)), Workers Compensation Insurance affidavit must be completed and submitted with this application. Fnilure 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 ON FOR BUILDING PERMIT 1,as Owner of the subject property, hereby authorize _ - t9 act on my behalf,in all matters relative to work authorized by this building permit application. Print Owner's Natue(Electronic Signature) Date SECTION 7b:OWNEW 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 npplica on is tr Lind accurate to the best of my knowledge and understanding. Print Owner's or Authori Agent's (Electronic 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 Home Improvement Contractor(HIC) Program),will Lint 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 tvww.mass.cov�ocn Information on the Construction Supervisor License can be found at www.�ns . 2. When substantial work is planned, provide the information below: Total floor area(sq. It.) '�.(including garage, finished basement/attics,decks or porch) Gross living area(sq. It.) 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 tor"total Project Cost'