16 CALABRESE STREET - BUILDING JACKET 16 Calabrese St. R-1
s
w
(91tU of ,5ttlem, HttssttLllusPtts
3
Q Pnzra of 'Ar
peal
_
� T
P
- G U7rf
CD
T'n j
DECISION OF THE PETITION OF LESLIE & LINDA WHITE REQUESTING A o
VARIANCE FOR THE PROPERTY LOCATED AT Y6 CALABRESE T �STREER_
A hearing on this petition was held October 20, 1999 with the following Board Members
present: Nina Cohen, Chairman, Stephen Harris, Michael Ward, Stephen Buczko and
Richard Dionne. Notice of the hearing was sent to abutters and others and notices of the
hearing were properly published in the Salem Evening News in accordance with
Massachusetts General Laws Chapter 40A.
The petitioner is requesting a Variance from side setback to construct addition for the
property located at 16 Calabrese Street located in an R-1 zone.
The Variances which have been requested may be granted upon a finding by this Board
that:
1.Special conditions and circumstances exist which especially affect the land, building or
structures involved and which are not generally affecting other lands, buildings and
structures involve.
2. Literal enforcement of the provisions of the Zoning Ordinance would involve
substantial hardship, financial or otherwise, to the petitioners.
3. Desirable relief may be granted without substantial detriment to the public good and
without nullifying or substantially derogating from the intent of the district of the
purpose of the Ordinance.
The Board of Appeal, after careful consideration of the evidence presented at the
hearing, and after viewing the plans, makes the following findings of fact:
1. Petitioner, Linda White, represented herself.
2. The variance was requested for the side setback in order to construct an addition.
3. The residence is located in an R-1 district where a minimum of 10 feet is required
for side yard width. The proposed addition would reduce the side yard width to 5
feet.
4. A plot plan prepared by Reid Land Surveyors of Lynn, Ma. Was presented to the
Board. In addition, a diagram of the proposed addition, prepared by First Choice
Construction, was presented to the Board.
5. There was no opposition to the proposal.
r
DECISION OF THE PETITION OF LESLIE & LINDA WHITE REQUESTING A
VARIANCE FOR THE PROPERTY LOCATED AT 16 CALABRESE STREET R-1
On the basis of the above findings of fact, and on, the presented at the hearing, the
Zoning Board of Appeal voted unanimously, 5 in favor, to grant the variances requested,
subject to the following condition;
1. Petitioner shall comply with all city and state statues, ordinances, codes and
regulations.
2. All construction shall be done as per the plans and dimensions submitted.
3. All requirements of the Salem Fire Department relative to smoke and fire safety shall
be strictly adhered to.
4. Petitioner is to obtain Building Permit prior to beginning any construction.
5. Exterior finishes of the new construction shall be in harmony with the existing
structure. n"
� r
6. A Certificate of Occupancy is to be obtained. x N
7. Petitioner is to obtain approval from any City Board or Commission having
jurisdiction including, but not limited to, the Planning Board. [J y
W rT�3
C=)
_
Variance Granted
October 20, 1999
Michael Ward, Member
Board of Appeal
A COPY OF THIS DECISION HAS BEEN FILED WITH THE PLANNING BOARD AND
THE CITY CLERK
Appeal from this decision, if any, shall be made pursuant to Section 17 of the
Massachusetts General Laws Chapter 40A, and shall be filed within 20 days after the
date of filing of this decision in the office of the City Clerk. Pursuant to
Massachusetts General Laws Chapter 40A, Section 11. The Variance or Special
Permit granted herein shall not take effect until a copy of the decision bearing the
certificate of the City Clerk that 20 days have elapsed and no appeal has been filed,
or that, if such appeal has been filed, that is has been dismissed or denied is
recorded in the South Essex Registry of Deeds and indexed under the name of the
owner of record or is recorded and noted on the owner's Certificate of Title.
I�iAT �f 1� 5Z �li '91
i Citu of �ttlem, fflassadjuset� 3 Ess
F ,goara of ��u{ienl
1.�� ,'
Fl r.I�II�'�JJ`
DECISION ON THE PETITION OF Leslie and Linda White
FOR A VARIANCE AT6 Calabrese Street (R=1')�
A hearing on this petition was held on May 15 , 1991,
with the following Board Members present: Chairman Richard
Bencal, Richard Febonio, Edward Luzinski , Jane Stirgwolt and
Joseph C. Correnti .
Notice of the hearing was sent to abutters and others , and
notices were properly published in the Salem Evening News in
accordance with Massachusetts General Laws Chapter 40A.
Petitioner is requesting a variance from the sideyard setback
requirement to allow a deck;
in this R-1 zone.
The variance requested may be granted upon a finding by
this Board that:
1. Special conditions and circumstances exist which
especially affect the land, building or structure involved and
which are not generally affecting other land, buildings and
structures in the district.
2. Literal enforcement of the provisions of the zoning
ordinance would involve substantial hardship, financial or
otherwise to the petitioner.
3 . Desirable relief may be granted without substantial
detriment to the public good and without nullifying or
substantially derogating from the intent of the district or the
purpose of the ordinance.
The Board of Appeal, after careful consideration of the
evidence presented at the hearing makes the following findings
of fact:
1. That the petitioner will have a nine foot setback from
the sideyard which is one foot short of the ten foot sideyard
setback requirement.
2 . That the direct abutter to the sideyard in question,
Ms. Marilyn Bishop; wrote a letter to the Board in strong
support of the granting of the petition.
DECISION ON THE PETITION OF LESLIE AND LINDA WHITE FOR A VARIANCE
AT 16 CALABRESE ST. , SALEM
page two h4'1 Z II 52 UJ '91
3. That there was no opposition to the petition during the pu]AllL_ '�prt on "ASS
of the hearing. Ltirc'• lCF
On the basis of the above findings of fact, and on the evidence presented, the
Board of Appeal concludes as follows:
1 . Special conditions exist which especially affect the subject property but
not the district in general.
2. Literal enforcement of the provisions of the Ordinance would involve sub-
stantial hardship to the petitioners.
3. The relief requested can be granted without substantial detriment to the public
good and without nullifying or substantially derogating from the intent of the
district or the purpose of the Ordinance.
Therefore, the Zoning Board of Appeal voted unanimously, 5-0, to allow the
Variances requested, subject to the following conditions:
1 . All rules and regulations of the Salem Fire Dept. & Fire Prevention Code be
strictly adhered to.
2. All construction be as per the plans and dimensions submitted.
3. Exterior finishes of the construction be compatible with the existing finishes.
4. A Building Permit be obtained.
5. The Salem Building Code be strictly adhered to.
Variance Granted
May 15, 1991
/Jose$b C. Correnti, Secretary, Board of Appeal
A COPY OF THIS DECISION HAS BEEN FILED WITH THE PLANNING BOARD AND THE CITY CLERK
AHpdai from tfils d0cNion, If any, shall be fnade pursuant to Section 17 of
the Mass. General Laws, Chapter 808, and shall be filed within 20 days
after the date of filing of this decision in the office of the City Clerk.
Pursuant to Mass. General Laws, Chac'.e:808, Section 11, the Variance
or special Permit granted he,ein slmll not take effect until a copy of the
decision, bearing the certification of the City Clerk that 20 days have
elapsed and no appeal has ueen filed, or that, if such appeal has been
tiled, that it has been dismissed or denied is recorded in the South Essex
Registry of Deeds and indexed under the name or the owner of record or
is recorded and noted on the owner's Certificate of Title.
BOARD OF APPEAL
Plans must be filed and approved by the Inspector
prior to a permit being granted
CITY OF SALEM
No. Ward
HISTORIC DISTRICT? �J Nv Date
IF FOR SIDING, HAS ELEU IC ° Home Phone
PERMIT BEEN OBTAINED?(Y) Nsp Bus. Phone
APPLICATION
FOR
PERMIT TO
TO THE INSPECTOR OF BUILDINGS:
The undersigned hereby applies for a permit to build according to the
following specifications:
Owner's name and address /
Architect's name
Builder's name 06
Location of building, No.
What is the purpose of building? �r�4
If dwelling, # of units? l Material of bldng?
Will building conform to law? ( _ Asbestos?
Estimated Cost SGGu City Lic.#� State Lic.11 X00 ` Srj
Home Improvement License #
Signature of Applicant
SIGNED U DER THE PENALTY OF PERJURY
DESCRIPTION OF WORK TO BE DONE
r
Mail Permit to:
045 t �Ll
No. Ward _
APPLICATION FOR
PERMIT TO ROOF
REROOF OR INSTALL SIDING
Locaflon t( (a r Q
PERMIT GRANTED
//��
Q r _ L_ -19(?21
Approved
6L
10CO, l B / g Inspe or`
City of Salem, Mass.
A ELECTRICAL DEPARTMENT
44 Lafayette Street
w'@ PAUL M. TUTTLE ,CITY ELECTRICIAN
DATE . . . / fi ' `. . . . . . . . . . .
To: INSPECTOR OF BUILDINGS
Salem, Mass.
Electrical Contractor
.:--... .---'A-------------r- QISignat(-iur:e of Applicant)
----.-----'`-, ------ /' -'..................................................._.---...
has signified their intention of performing the required electrical
work, viz: removing and later replacing all electrical wires, fixtures,
receptacles, etc., on outside of building located at:
Street
------------------------------------------------------------------------------
in conjunction with a wall siding installation to be made by:
- >f f.-- n•' '� ' -...Siding Contractor
i .......... ---- --------------------- ------- -------------- ------'-'-----------
ISSUED BY `
----------------------------------------------------------------------------------------
This is a requirement, preliminary to the issuance of a permit
for the sidewall installation by the Inspector of Buildings.
ORIGINAL-SIDEWALL INSTALLER
PINK COPY-BLDG. INSP.
YELLOW COPY-ELEC. FILE
L� ( F--1
The Commonwaa� Netachusetts
r Board of Built ns�aLr,7�cr�1p,�,,L�rds CITY OF
Massachusetts State Building Code,7 CMR SALEM
' Revised Mar 2011
Building Permit Application' #J1 ,MpF7R*iWJnpvate Or Demolish a
One-or Two-Fami y Dwelling
This Section For Official Use Only
Building Permit Number: Date Applied:
JT Z
Building Official(Print Name) Si re Date
SECTION 1:SITE INFORMATION
(L1 rop ty A dress: 1.2 Assessors Map& Parcel Numbers
Q I G IFSQ S'�
I.1a Is this an accepted street?yes no Map Numher Parcel Number
1.3 Zoning Information: 1.4 Property Dimensions:
Zoning District Pruposed Use Lot Area(sq f) Frontage(11)
1.5 Building Setbacks(ft)
Front Yard Side Yards Rear Yard
Required Provided Required Provided Required Provided
1.6 Water Supply:(M.O.t,c.40,§54) 1.7 Flood Zone Information: 1.8 Sewage Disposal System:
Public❑ Privatc❑ Zone: _ Outside Flood Zone'? Municipal ❑ On site disposal system ❑
Check ifyes❑
�/ `Q g SECTION 2: PROPERTY OWNERSHIP'
le
Name(Print) L City,State,ZIP
lG AI brese s4 -74 Z< r �abqf
No.and Street Telephone Email Address
SECTION 3: DESCRIPTION OF PROPOSED WORK'(check all that apply)
New Construction ❑ Existing Buildin Owner-Occupied.? Repairs(s) Alteration(s) ❑ Addition ❑
Demolition ❑ Accessory Bldg. ❑ Number of Units I Other ❑ Specify:
Brief Description of Prolc p osed Work 2: -
-� —�� �
SECTION 4: ESTIMATED CONSTRUCTION COSTS
Item Estimated Costs: Official Use Only
Labor and Materials
1. Building $ 1. Building Permit Fee: $ Indicate how fee is determined:
2. Electrical $ ❑Standard City/Town Application Fee
❑Total Project Cost (Item 6)x multiplier x
3. Plumbing - $ 2. Other Fees: $
4. Mechanical (FIVAC) $ List:
5. Mechanical (Fire $ —
Suppression) Total All Fees:$
Check No. Check Amount: Cash Amount:
6. Total Project Cost: $ 7 / 0 Paid in Full 0 Outstanding Balance Due:
SECTION 5: CONSTRUCTION SERVICES '
5.1 Construction Supervisor License(CSL) "i t,�'�i +
, . �-Of3fly e Slie
License Number Expiration Date
Name of CSI.Holder
153
�C ( List^CSL Type(see below) (�
No.and Street Type Description
U Unrestricted(Buildings up to 35,000 cu.ft.)
R Restricted 1&2 Family Dwelling
City/Town,State,ZIP M Mason
ry
RC Roofing Covering
WS Window and Siding
771/ 3&P S09 SF Solid Fuel Burning Appliances
1 Insulation
Telephone Email address D Demoon
5.2 Registered Home Improvement Contractor(HIC) /6 r//G 3 �/fr
{I�rn of bw �MO(�!`f�9 HIC Registration Number Expiration Date
11/1�Cr�Com ny N.une or IIC R _istrant Name
o. tree[ 77�!��r z Email address
Cit /Tow ,State,ZIP [ G'teetleephtoone
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 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.
Print Owner's Name(Electronic Signature) Date
SECTION 7b: OWNER[OR AUTHORIZED AGENT DECLARATION
By entering my name below, 1 hereby attest under the pains and penalties of perjury that ail of the information
contained in th' p t [ion is true and accurate to the best of my knowledge and understanding.
Print Owner'� uthor ed Agent's Name(Electronic Signature) Date
NOTES:
I. 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.gov/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 ofcooling system Enclosed Open
3. "Total Project Square Footage"may be substituted for"Total Project Cost"
The Commonwealth of Massachusetts CITY OF
Board of Building Regulations and Standards SALEM
Massachusetts State Building Code, 780 CM . Revised Mar 2011
�vJ Building Permit Application To Construct, Repair Renovate Or Demolish a
(� dd One or Two-Family Dwelling
Uy Tlus Sact on Far Offictal Use O ily 4
Buddi"ng Permit N umber
Date APPI tvY f f.
z a ey*�R3
W ;�
Building Officia6(Pr tName) ' .� :Signature �-^ `' ri c,z_ r r D—
... . . -
SECTION1 SITE INFORMATION
1.1 Property Address: y 1.2 Assessors Map& Parcel Numbers
1(e Calabiese Sfreef
L l a Is this an accepted street?yeses 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:
Zone: _ Outside Flood Zone? Municipal El On site disposal system ❑
Public❑ Private El Zone:
if yesO
F „SI`CTION 2 `'PROPERT Y OWNERSHIP'` ,
2.1 Owner'of Record:
tes)t � why Salem titA 01g70
Name(Print) City,State,ZIP
I& Ga/a/&iexexlylezt- 97?-7YS-o2v45
No.and Street Telephone Email Address
SECTION 3 DESCRIPTION OF PROPOSED WORW(check a hat apply)"
New Construction❑ 1 Existing Building❑ Owner-Occupied ❑ Repairs(s) Alteration(s) ❑ Addition ❑
Demolition ❑ Accessory Bldg. ❑ Number of Units Other ❑ Specify:
Brief Description of Proposed Work':
<Si-r.'o anol reroo�' ho✓re W r'N C2{�F cl2llr%?��//a.l SH t'�� )� � — �p S"
;SECTION 4: ESTIMATED.CONSTR[�CTION CASTS
r
Estimated Costs:
Officlal'Use Onl
Item ya
Labor and Materials '�� �:`
1. Building $ l9 pg 1 Bdil1d ig Permit Fee $ F. Indicatehow fee is determined
❑ Standard Cttyl.T n Apphca on Fee z
2. Electrical $
❑Total Piolect Cost'(Itdm 6)xmultipher x
3. Plumbing $ 2 Other Fe°es $ `h `✓ J
4. Mechanical (HVAC) $ _ List
m
.hn ,r
5. Mechanical (Fire $ Total All Fees $
Suppression)
Check No Check Amount k> Gash Amount
6. Total Project Cost: $ 1 cJ loci Ell P,atd in.Full . ❑ 014tan,dmg Ba1'ance,D'ue:
1
SECTION 5 CONSTRUCTION SERVICES
5.1 Construction Supervisor License(CSL) 9 7G/ S 7
LE�IA„ �p�Nl ✓' License Number Expiration Date
Name of CSL Holder r[
3 Gh/,,rfiq� /��. fllalh✓R IVf U3O 6,� List CSL Type(see below)
No. and Street Type - Description
U Unrestricted(Buildings up to 35,000 cu. ft.
R Restricted 1&2 Family Dwelling
City/Town, S te,ZIP M Mason
ry
RC Roofing Covering
WS Window and Siding
SF Solid Fuel Burning Appliances
teio Y-S000 x 3Y3 j I Insulation
Tele hone Emait address D Demolition
5.2 Registered Home Improvement Contractor(HIC) G P6�` J ,S 's
I°o I��� riLQ-fit n °' HIC Registration Number Expiration Date
HIC Com}any Name or HIC ReP�rstrant NMile
oZ 501 S2aod/� ()/I✓�
No. and Street Email address
C:h ,Srfe-Aq foiol � (a to-8� 1-5000
City/Town, State,ZIP 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 of the building permit.
Signed Affidavit Attached? Yes .......... No ........... ❑
SECTION Tar OWNER AUTHORIZATION TO BE COMPLETED WHEN
OWNER'S AGENT OR CONTRACTOR APPLIES FORBUILDINGPERMIT
I, as Owner of the subject property, hereby authorize A llgn KOletffr 94Z!�7
to act on my behalf, in all matters relative to work authorized by this building permit application.
L-eslie while " cankact 'Y&L3
Print Owner's Name(Electronic Signature) Date
SECTION 7b: OWNER' 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.
Albs, Col tlfr Pc}e� s < /3
Print Owner's or Authorized Agent's Name(Electronic Signature) Yale
NOT
NOT
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.rnass.eow'oca Information on the Construction Supervisor License can be found at www.ntass.gov:dns
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"
4
^ The (\nnnnmv+calth of i\lassachusetis - —
t y Board of Building Regulations and Standards
i Massachusetts State Building Code, 780 CMR, 7"' edition
Buildin_I Permit Application To ('unload. Repair. Reno%ate Or I)entoli,h a R, I I,,d
Om- or Tit u-ftimiirOv<'iloft,l'
phis Section For Official l`se Only -- j
Building Permit Nu nber: _ Date Applied.
Si,_nmure:
m it Cunum„lon lnr of Buildings Date
Limit
m
0101
SECTION I: SITE INFORM % PION --_-- -
1.1 Proper v .1d d;R&W
srL? Assessors .Ylap & Parcel .Numbers _.._----- - -
1. la Is This an accepted sneer' yes___ nil :\lap Number _-_- P.arcl \w::hrr
L3 Zoning Information: 1 1 J Property r : -e;lions: -_- ------
_ I
1.5 CSuriuia-.
i
i Front Yard
Side Yards I Rear Y:rd
I ReyuirrJ PnrvtJcJ Rcc un cJ
I -_ .— Fru_:ved_ I Rc4uireJ � PiusldcJ _I
LWater Supply: IS1.QL e. 10, §.; 1.- Flood Zone Information: 1.8 Sewage Disposal System:
c❑ Private❑ Zone: _— Outside Flood Zone?
Check if yes❑ Municipal ❑ On >ice disposal tiy,lcm ❑
_ SECTION2: PROPERTY OWNERSHIP'
1.1 Ow��eryy r of Record: —�
\.m;,I Pri 1 Address for Service: I
itgnot re Telephone —" -
SECTION 3: DESCRIPTION OF PROPOSED WORK'(check all that apply)
�Ne,v('. rsu ucno't Q 1 Existing Building ❑ 1 Owne -0 rccupied ❑ Repatr s(s) ❑ Alteration(s) ❑ :\JJi(iun ❑
.-----
Demolition ❑ Accessary' BIJg. ❑ 1 Number of Units —I Other ❑ Speco).
Brief Description of Proposed \ ork:
SEC TION 4: ESTIMATED CONSTRUCTION COSTS — --
Estimated Costs: - ---�1
qNfechanical (Fire
Official Use Only
(Labor:tad Materials)
ng Y I. Building Permit Fee: S Indicate havw tee t, delernuned:
ical S ❑ Standard City/Tosvn Application Fee
❑Total Project Cost' (Item 6) x multiplier _
ing S ' Other Fees:
mcal IBb':\C) .S List
t -—
nical (Fire - i
nn) STotal :\II Fees:—
Check No, Check .-Amount (•ash :Anl�wne
Project Cost: 5 �} -
v ❑ Paid in Full ❑ Oulstandmg Bul:mce I
i
I
r
r
I
SECTION 5: CONSTRUCTION SERF°ICES __-___.�-•
S.l Licensed Construction Supervisor IC'SLI
License Nullifier I[>pu:wi,n D.ne
N,rnn•of ('51. Milder 1.1,1 CSI_'I\pe Isre hrlow 1
_ Tv c Descn nl.m _
\ddress 1. tmcsu'Icicd ni to )S.IX)O Cu. Ft
R Reslrlrh•d L\C_' F..... Dslilline
_- \f \lasonrn Only
S l g l l lltll le _
RC Resi&I!(lJl Ruuline CIiserur�_—_—_.
\1S I2<aJnwal \\inJ.,o ..lid Snlin` ____.____- -
I'rlephi'°`' SF Re,ldenu.11 Sol fuel 8onwia \j1h.w_In.l
i
D Residenoul Uruuihw al
5.2 Registered home Improvement Contractor IIIICI
12eguuatron Numincr—
HIC Company Name or HIC Registrant Name
Address FNputill a Data
Telephone _
SigiWWfC _.— -- —
SECTION 6: WORKERS' CONIPENSATION INSURANCE AFFIDAVIT (M.G.L. c. 152. 4 '-5C(6))
Workers Compensation Insurance affidavit must be completed and submitted with this ;IpPliratiun. Failure hi pniside
this affidavit will result in the denial of the Issuance of the building permit.
Signed Affidavit Attached? Yes ......._. ❑
No —
Signed ❑
SECTION 7a: OWNER AUTHORIZATION TO BE COMPLETED WHEN
OWNER'S AGENT OR CONTRACTOR APPLIES FOR BUILDING PERMIT
as Owner of the subject property herebv
to act on my behalf, in all m:utel s
authorize
.elative to tv,i.k authorized by this building permit application.
I
Date
Si n ture of Owner
SECTION 7b: OWNER[ OR AUTHORIZED AGENT DECLARATION
as Owner or Authorized Agent hereby declare
1.
e and accurate, to the best of my knowledge:m
that the statements and information on the foregoing application are tru
behalf.
QG
�
Print Name z Z i��� Date �I
Signature at owner or:\uthonzed:\gent
ISi 'ne Ile Dins and allies of er ') NOTES:
1. An caner who obtains a building permit ro do his/her own work.or :m owner who hires an unregismrcJ runt ra.nn�
(nut registered in the Hume Improvement Contractor(HIC) Program). will root has'e access i" [ne ;irhin:uion
program or guaranty fund under M.G.L. c. 11'_A. Other important mrormation on the HIC Prom-an and
Construction Supervisor Licensing (CSL) can be tilund in 780 CMR Regulations I IO.R6 :ind 110.R5, rc>pectlsel)'.
When substanttal work is planned, pr
ovide the information below:
including garage. finished bmement/attic s, decks or purehl
Total Iloors area ISq. Ft.) Habitable room coum —
Gross living area iSy. Ft.) Number of hedroums ---_- _
Number of tirePlaces Number it -----.-- --
Number of hathnxwts Number tit decks/ pinches _'— ----- -
I'.pe of healing system __. Lncli oed _ _-Upon
fv'pe of coohllg system —
7 "Total Project Square Footage• may be ltlbstituted tiir -'moll Prolect Copt'