25 CALABRESE ST - BPA-11-852 The Commonwealth of Massachusetts
b Board of Building Regulations and Standards CITY Oq201
Massachusetts State Building Code, 780 CMR SAL.EM
Revixerl l/ar
Building Permit Application To Construct, Repair, Renovate Or Demolish a
One-or Two-Fumily Divelling
•` ^IV\ Building Permit Number: This Section For Official Use Only.,
Date Appl' d:
Building OlPcial(Print Name) Signa Date
R Co- es2 SECTION 1: SITE INFORMATION
1.1 Property Address: S 1.2 Assessors Map& Parcel Numbers
�5 Go-I o- 6iGSG s��G t
1.la 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 It) Frontage(II)
1.5 Building Setbacks(ft)
Front Yard Side Yards Rear Yard
Required Provided Required Provided Required Provided
1.6 Water Supply: (M.G_I,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'
2.1 Owner'of Record: 1179 0 j q7,2
tk o-f, e //o-.1 4 e r AIL n
N:une(Print) City,State,ZIP
25 Grl V-1,/GSe Sf 9iF- -Y9n1
No. mid Street 'telephone Email Address
SECTION 3: DESCRIPTION OF PROPOSED WORK'(check all that apply)
New Construction ❑ Existing Building❑ Owner-Occupied ❑ Repairs(s) ❑ Alteration($) ❑ 1 Addition ❑
Demolition ❑ Accessory Bldg. ❑ Number of Units Other ❑ Specify:
Brief Description of Proposed Work': / �,•.�'na E.Yflrio� /douse
SECTION 4: ESTIMATED CONSTRUCTION COSTS
Item Estimated Costs: Official Use Only
Labor and Materials)
I. Building $ 1. Building Permit Fee: $ Indicate how fee is determined:
'. Electrical g ❑Standard City/Town Application Fee
❑Total Project C-o (Item 6)x multiplier x
3. Plumbing $ 2. Other Fees: $
4. Mechanical (HVAC) S List:
5. Mechanical (Fire $
Total All Fees:
Suression) $
Check No. Check Amount: Cash Amount:
6, Total Project Cost: $ 41165, aO ❑Paid in Full I7 Outstanding Balance Due:
t
7--
ECTION 5: CONSTRUCTION SERVICES r
` 5.1 ction Supervisor License(CSL)
� � a83 � y -a � -/�
QLCo/1 ,',f � License Number Gcpiralion Date
Nancolder
a/ A —f/ p� List CSL Type(see below)
No.aO / r.N Description
IVA 03 O 38 U Unrestricted(Duildin�s u' to 35,000 cu. ft.)
R Restricted IX2 Famil DwellinCrtylte.ZIP MMasonry
RC Rootin CovermWS Window and SidinSF Solid Fuel Burning Appliances
V/719 I Insulation
Tele Email address U Demolition
5.2 Registered Home Improvement Contractor(HIC)
I ERegistrationmber Expiration Date
I IICCompany Name or I IIC Registrant Name
No.and Streetmail address
City/Town, State,ZIP Tele 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 .......... ❑ No........... ❑
SECTION 78: 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.
/ Print Owner's Name(Electronic Signature) Date
SECTION 7b: OWNEW OR AUTHORIZED AGENT DECLARATION
IBy entering my name below, I hereby attest under the pains and penalties of perjury that all of the information
onttaiined in this application is true and accurate to the best of my knowledge and understanding.
[/Ca /I M LCa ih ''3 ti 6 —o2S- //
Print(hvner's or Authorized Agent's Name(Electronic Signature) Dale
NOTES:
[G:ross
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 NI.G.L.c. 142A.Other important information on the HIC Program can be found at
m: ����ovoca Information on the Construction Supervisor License can be found at yv�ti wn uisao-os_41L. When substantial work is planned, proviotal floor area(sq. ft.) (including garage, finished basement/attics,decks or porch)
living area(sq. fl.) Habitable room count
Number of fireplaces Number of bedrooms _
Number of bathrooms Number ofhalFbaths _
Type of heating system Number ofdecks/porches
Type of cooling system _ Enclosed_ Open
3. "Total Project Square Footage"may be substituted for"total Project Cost"