24 CALABRESE ST - BPA-2010-820 -�� av!
The Commonwealth of Massachusetts
i Board of Building Regulations and Standards CITY
!y ) Massachusetts State Building Code, 780 CMR "edition OF SALFM
�rZ , T Revised Junuary
Building Permit Application To Construct, Repair, Renovate Or Demolish a 1. 'ooR
One-or Two-Family riling
This Section For O t is Use O I
/ Building Permit Number: I Da a pplie .
Signature:
Building Commissioner/Inspect 'of Buildings
SECTION 1:SITE WiMMATION
1.1 Property 9ddess: /j G / _ 1.2 Assessors Map& Parcel Numbers
I.l a Is this an accepted street?yes_ v�no Map Number Parcel Number
1.3 Zoning Information: 1.4 Property Dimensions:
Zoning District Proposed Use Lot Area(sq B) Frontage(11)
1.5 Building Setbacks(R)
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:
Zone: Outside Flood Zone?
Public❑ Private❑ —
Check if es❑ Municipal❑ On site disposal system ❑
SECTION 2: PROPERTY OWNERSHIP'
2.1 Ow2ert9f Re�Cor�d:
Name(Print) Address for Service:
Signature Telephone
SECTION 3: DESCRIPTION OF PROPOSED WORK'(check all that apply)
New Construction❑ Existing Building Owner-Occupied ❑ 1 Repairs(s) Alteration(s) ❑ 1 Addition ❑
Demolition ❑ Accessory Bldg.❑ Number of Units_ Other ❑ Specify:
----_,-
Brief Description of Proposed Work': ,
SECTION 4: ESTIMATED CONSTRUCTION COSTS
Item Estimated Costs: Offlelal Use Only
Labor and Materials
I. Building $ 1. Building Permit Fee:S Indicate how fee is determined:
2. Electrical S ❑Standard City/Town Application Fee
❑Total Project Cost'(Item 6)x multiplier x
3. Plumbing S 2. Other Fees: S
4. Mechanical (HVAC) S List:
5. Mechanical (Fire S
Su ression Total All Fees: S
pl Check No._Check Amount: Cash Amount:
6.Total Project Cost: Svc-'' sa� y° ❑Paid in Full ❑Outstanding Balance Due:
I �GU✓ �� l� /fjll r O/�,��
SECTION 5: CONSTRUCTION SERVICES
5,1 Licensed Construction Supervisor(CSL) 7 ,? �p ,zT)utc
7LJy)
License Number Fa imtion +
Name of 'S --Ifolder / List CSL Type(see below)
.f� Descri Lion
s - U unrestricted(up to 35,000 Cu.Ft.
/ R Restricted 1&2 FamilyDwellinit
Sigm;tl�rr,� ` 7(f t� M Mason Only
V7
lG�� jZJ} 7 ` RC Residential Roofing Covering
'I"clephone WS Residential Window and Sidin
SF Residential Solid Fuel Burning Appliance Installation
D Residential Demolition
5.2 Registery�d Hom�pQrot/yemeot nt clot(HIC) / 50VSa
/� C (e Resist tion lumber
I11C Company Name or tlIC Registrant Name /
AJdre ,/ I Q`
3s, 3 m �� � \ r _ !j_�`� ap lion Date
Signal Telephone
SECTION 6: WORKERS'COMPENSATION INSURANCE AFFIDAVIT(M.G.L.c. 152.f 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...........O
SECTION 7a:OWNER AUTHORIZATION TO BE COMPLETED WHEN
OWNER'S AGENT OR CONTRACTOR APPLIES FOR BUILDING PERMIT
1 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.
Signature of owner Date
SECTION 7b: OWNEW OR AUTHORIZED AGENT DECLARATION
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. ) / e
G
P dN /
S alum of )wner or Authorized Agent D le
(Signed under the 2ains and penalties of 'u
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 nyj have access to the arbitration
program or guaranty fund under M.G.L.c. I42A.Other important information on the HIC Program and
Construction Supervisor Licensing(CSL)can be found in 780 CMR Regulations I I O.R6 and 110.115, respectively.
? 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"maybe substituted for"Total Project Cost"