18 CABOT ST - BPA-13-587 The Commonwealth of Massachusetts
u� Board of Building Regulations and Standards FOR
U Massachusetts State Building Code, 780 CMR MUNICIPALITY
USE
Building Permit Application To Construct, Repair, Renovate Or Demolish a Revised Mar 2011
One-or Two-Family Dwelling
._ "-This Section For Official Use Only
iBuildmg Permit Numbeft ,a aB.aC_ _ •p Date A lied. _.ui _c
uildingOfficial(PrintName) > r«,!,. °,. , F?�eS, Signature
_ . Date
B
..�... _ M
hu , ..,. . ""`SECTION 1: SITE INFORMATION—,
1.1 Property Address: 1.2 Assessors Map& Parcel Numbers
i Ca�l�f S't
1.1a 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❑
.:r : SECTIO1v2:;PROPERTYOWNERSHIPi
_.. .
2/..1 Owner'of Record:
f inn( S�jYL Q1' - tsi en M O -,
Name(Print) Ciry,State,Z P
IF, C, �`f St
No.and Street Telephone nature
SECTION 3:DESCRIPTION OF PROPOSED,WORKZ(check all that apply)
New Construction❑ FFxisting Building❑ Owner-Occupied ❑ Repairs(s) ❑ 1 Alteration(s) ❑ Addition ❑
Demolition ❑ 1 Accessory Bldg. ❑ Number of Units Other ❑ Specify:
Brief Description of Proposed Work':
,
MF
SECTION 4iESTIMATED CONSTRUCTION COSTS
Estimated Costs:
Item : c Ocial Use Only r,
(Labor and Materials) ffi „u
1.Building $ SY�d J. Building Permit Fee $ '. Indicate how fee is determined
❑ Em
Standard,City/Town Application Fee' -fU
2. Electrical $ �� A ._ , ,.
❑Total Project Cost'(Item 6)x multiplier '• x °
3.Plumbing $ 2 Other Fees $ � ° ° J "
4. Mechanical (HVAC) $ List c '
G:.
5. Mechanical (Fire r "
ff
Suppression) $ Ch _c a, 4
eck `.Check Amount Cash Amount
6.Total Project Cost: $sQ Q ❑paid m Full -, O Outstanding Balance Due ° w
'���� - �a;cne•L - - I
4,`13P.Ee SECTION 5: CONSTRUCTION SERVICES, , , =-;
.. .::��Ln'�.a awn...... ..m... .�.}... nn imv.
5.1 Construction Supervisor License(CSL)
2123 5/24/19
Glenn R Battistelli License Number Expiration Date
Name of CSL Holder
List CSL Type(see below) U
11 Broadway-R/P.O. Box 496 � _ n v' r
Typez} m, F5 Description ME,Rr �
No.and Street - -
U Unrestricted(Buildings up to 35,000 eu.ft.
Beverly, MA 01915 R Restricted 1&2 FamilyDwelling
City/Town, State,ZIP M Masonry
RC Roofing Covering
WS Window and Siding
SF Solid Fuel Burning Appliances
-�'
(978) 927-8956 ZI Insulation
Telephone ° Si nature D Demolition
5.2 Registered Home Improvement Contractor(HIC)
172956 7/3/19
Glenn Battistelli LLC HIC Regist tion Number Expiration Date
HIC Company Name or HIC Registrant Name
281 Dodge St
No.and Street Signature
Beverly, MA 01915 (978) 927-8956
City/Town, State,ZIP Telephone
SECTION 6 WORKERS' COMPENSATION INSURANCE AFFIDAVIT,(M G L c 152.,§ 25C(6)) R,m
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
`..__ UE OWNER'S AGENT OR CONTRACTOR APPLIES FOR BUILDING-PERMIT `.'I'm �,,
1, as Owner of the subject property,hereby authorize Glenn Battistelli
to act on my behalf, in all matters relative to work a orized by this building permit application.
x ,ply/1�,
Print Owner' ame(Signature) Date
SECTION 76:OWNER'wOR 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.
_Glenn Battistelli 1�1�13
Print Owner's or Authorized Agent's Name(Signature) Date
AaLvc-m 05—i�. — '.C.,t 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. a 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.eov/dps
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"maybe substituted for"Total Project Cost"