27 BERTUCCIO AVE - BPA-14-275 RETAINING WALL/STAIRS sa
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The Commonwealth of Massachusetts
Board of Building Regulations and Standards CITY OF
Massachusetts State Building Code, 780 CMR SALEM
Retnsed Mar 2011
Building Permit Application To Construct, Repair, Renovate Or Demolish a
One-or Two-Family Dwelling
This Section For Official Use Only
Building RermitNumber: - ` �Ti to Applied` of
77
Building Official(Print N ) S Date
SECTION 1: STI ORMATION
1.12P`roo er?g s_T!_ t° �{ - _ 1.2 Assessors Map&Parcel Numbers
4 �1SS ) 0 �V
I.I a Is this an accepted street?yes_ no Map Number Parcel Number
13 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'
2.1J(4 Savrran`&YPI,�S?�k
` Name(Print) City,State,ZIP
2 R�&crjL ILP Q797yf5l/-;-y V7PZ63PSLa 11CYi-WA I
No.and Street Telephone Ems ai ddress
SECTION 3:DESCRIPTION OF PROPOSED W OR W(check all that apply)
New Construction❑ Existing Building❑ Owner-Occupied ❑ Repairs(s) ❑ 1 Alteration(s) ❑ 1 Addition ❑
Demolition ❑ Accessory Bldg. ❑ Number of Units Other ❑ Specify:
Brief Description of Proposed Work': a P
SECTION 4:ESTIMATED CONSTRUCTION COSTS
Item Estimated Costs: Official Use Only
(Labor and Materials
1.Building $ Z 1. Building Permit Fee: $ Indicate show fee is determined:
❑Standard City/Town Application Fee
2.Electrical $ ❑Total Project Cost'(Item 6)x multiplier - x
3.Plumbing $ 2. Other Fees: $
4.Mechanical (HVAC) $ List: iy
5.Mechanical (Fire $ Total All Fees:
Su ression
Check No. Check Amount: Cash Amount:
6. Total Project Cost: $ ❑Paid in Full ❑ Outstanding Balance Due:
A
SECTION 5: CONSTRUCTION SERVICES
51 iC6nstivciion Supetwisot•Litense(CSL) ('C'_ ) Q/cl ff 6 Z 10 1 200
License Number Expiration Date
Naroe o CSL Holder t �
List CSL Type(see below) 1�l
Y- Type Description
No.and Street
V`e r.r n/J� / /(�� U Unrestricted(Buildings u to 35,000 cu.ft.
`"� , R -Restricted 1&2 Family Dwelling
city/Iown,State,ZIP M Masonry
RC Roofing Covering
WS Window and Siding
�-7 �j ( SF Solid Fuel Burning Appliances
7�I l/ / Y�1/ ��l7uZ l�C G{dJCO�t� I Insulation
Telephone Email address D Demolition
5:2 Reg_istered Home"Improvem Improvement Contractor(HIC)
r 1.0 '.,CR&I / n! 1 iY'P (�r 1{r''Q j/-,P1 HIC Registration Number Expiration Date
HIC Coml any Name or HI Registrant Name
Nq= AIA 0171 a O ��O Email address
City/Town, State,ZIP /d JT�eI hone
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 .......... O 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: 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 application is true and accurate to the best of my knowledge and understanding.
Prin Owner's or Authorized Agent's Name(Electronic 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.gov/oca Information on the Construction Supervisor License can be found at www.mass.goyMps
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"