18 CALABRESE ST - BPA-14-1084 Urlyru
g The Commonwealth of Massachusetts INSPECTI NAL'' VICES
^t4, Board of Building Regulations and Standards
I� Massachusetts State Building Code,780 CMR,7th edition MUNICIPALITY
Building Permit Application To Construct,Repair,Renovate Or Dem 4 vise January
One-or Two-Family Dwelling 1,2008 -
`This Section For Official Use Only
Building Permit Number Dale Applied;
Signature.
�i, ' BuddingCarrin ionedlnspectorofBuildings Date -
t,, SECTION 1:SITE INFORMATION 4i
1.1 Property Add/r�eesss� 1.2 Assessors Map&Affe nizatiers.
l.la Is this an accepted street?yes_ no Map Number it .qz1 Number
1.3 Zoning Information: 1.4 Property Dimensions:
Zoning District_ Proposed Use Lot Area(sq.ft) Frontage(ft)
1.5 Building Setbacks(11)
• 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 Q Zone: _ Outside Flood Zone? Municipal❑ On site disposal system ❑
Check if es❑
SECTION 2 ,PROPERTY OWNERSHIP'
2.1 NeOwner'ofRecord•�' lbµ [' - •-- '
Name(Print) Address for Service:
—(�(Aat g �fi �,ery b 0/7 9-- -7 ys Z03t1
. .Signature.., Telephone -
SECTION 3A)EkR' IPTION OF PROPOSED WORK2(check all tint apply)
New Construction Existing Building❑ Owner-Occupied ❑ Repairs(s) Q Aheration(s) Q Addition ❑
Demolition ❑ Accessory Bldg.❑ Number of Units I Other ' Specify: T7✓Sux
it'Brief l)escriptionofPro osedWork2:
�rn Ce 'Z ?
5- j-D&UY
SECTION 4 ESTIMATED CONSTRUCTION COSTS
Estimated Costs:
ItemOfficial Use Only ,
µ Labor and Materials) .
+ .
I. Building Permit Fee.$ Indicate how_ fee is determined:
I.Building $ S(%f�Q. '
l7 Standard City/I own Application Fee
2.Electrical $
❑Total Project Cost?(Item 6)x multiplier x
3.Plumbing $ 2 Other Fees: $
4.Mechanical (HVAC) $ List: "
5.Mechanical (Fire
Suppression) $ Total All Fees:$
Check No. Check Amount: Cash Amount:
6.Total Project Cost: $ a . ❑Paid in Full ❑Outstanding Balance Due ` -
}}
J5
' ^tf `tily SECTION5: CONSTRUCTION SERVICES
5.ldtiicensod Coit"str'action�S$pervisor(CSL)
Licence Number .•Expiration Date -
NameofC$L•£Holdrei� � '(- t „ (� -
3 Ififtm iftet - List CSL Type(see below)
Address Salem MA 8]9]Q Des ' tion `.:
U Unrestricted u to 35 000 Co.Ft.
Signature R Restricted l&2 FamilyDwelling
� M Masonry Only
RC Residential Roofmg Covering
Telephone W S Residential Window and Siding
n y t _ �J SF Residential Solid Fuel B Appliance Installation
D Residential Demolition
5.2 Registered Home Improvement Contractor(RIC) - y�0 Sri
HIC Company Name 6I K
tit1d11;l;I;GC WP.a(ilfr1%MW7811)my Fme �Regi 'on Number
Address .ICI MA 019" 2 /2. /&.
Salem - ✓Expiration Date
Signature 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 o e building permit.
Signed Affidavit Attached? Yes.......... No.........:.❑
SECTION 7a:OWNER'AUTHORIZATION TO BE COMPLETED WHEN
OWNEk'8AGEN'iiDIt'CO' 'NTRACTOR"PIJES:FOR,BUILDINGPERAHT
as Owner of the subject property hereby
authorize E(, L �a �M to act on my behalf,in all matters
relative to work authorized by this building permit application.
Signature of Owner - Date
` SECTION 7b:OWNERr ORAUTHORIZED AGkiit.DECLARATION
I, Y ( 1 Q l P't, as Owner or Authorized Agent hereby declare
that the statements and information on the foregoing application are true and accurate,to the best of my knowledge and
behalf.
Er< c Po�. (
Print Name
go P Wain
ra /ul��
Signature of Owner or Authorized Agent Date -(Signed under the pains and penalties of
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 and
Construction Supervisor Licensing(CSL)can be found in 780 CMR Regulations I10.R6 and I IO.R5,respectively.
2. When substantial work is planned,provide the information below:
Total floors 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"