24 HANSON ST - BUILDING INSPECTION (4) r Z L-(
rile Commomvealth of Massachusetts
Board of Building Regulations and Standards CITY OF
Wl�c
Massachusetts State Building Code, 730 CMR SALENI
Building Permit Application To Construct, Repair, Renovate Or Demolish a Revised,t/ar »l�
One-or Two-Family Dwelling
This Section For Ot2icial Use Only.,:;
Building Permit Number: - Date Applied
Bwldmg OlTtcml(Pont Name).
Signature- Date
P oP tY�Ildt'ess: SECTION 1:SITE INFORt�fATION`
LI
1.2 Assessors Map& Parcel Numbers
1.1 a Is thlisanaccepted street?yes_ no— Map Nwnber .
I arcel Number
1.3 Zoning information: 1A Property Dimensions:
Lwting District Proposed U�—
Lot Area(sy tl) Frontage(It)
la Building Setbacks(ft)
uired Re
Front Yard Side Yartls
Rear Yard
4 Provided Reyuircd Provided
Required Provided
1.6 Water Supply:(M.G.L c.40,§54) 1.7 Flood Zone Information:
Public❑ Private❑ Zone: _ Outside Flood Zone? 1'$Sewage Disposal System:
Check if yes❑ Municipal❑ On site disposal system ❑
2.1 Owner'of Record: SECTION 2: PROPERTY OWNERSHIP,
,hme(Print) City,State,ZIP
Nu.mid Street
Telephone Email Address
SECTION 3: DESCRIPTION OF PROPOSED WORK?(check all that apply)
New Construction ❑ Existing Building❑ Owner-Occupied ❑ 1 Repairs(s) ❑ Alteration(s) ❑ Addition ❑Demolition ❑ .accessory Bldg. ❑ 1 Number of Units
Brief Description of Proposed Work': Other G $pecity:
SECTION 4: ESTIBIATED CONSTRUCTION COSTS
Item Estimated Costs:
Labor and Materials Official Use Only
I. Building S I. Building Permit Fee:$ Indicate how fee is determined:
2. Electrical $ ❑Standard City/Town Application Fee
3. Plumbing S ❑Total Project Cost"(item 6)x multiplier x
2. Other Fees: S
4. Mechanical (FIVAC) S List:
5. Mechanical (Fire
Su ression) S Total All Fees:S
6. Total Project Cosh .S Check Nu._Check Amount: Cash Amount:
❑Paid in Full 3 Outstanding Balance Due:
y t
SECTION 5: CONSTRUCTION SERVICES
06%6
5.1 Construction Supervisor License(CSL) Ev iration Date
n k d rl per'�r --- License Number P
GQ( I N List CSL'fYP e( low)
be
Nanrc of CSL Holdcr , .
'Type Description
ry
No. Lind S eet ( I-- .1 _ U Unrestricted 2 F!,mi s u el ing Co. tlJ
�// V R Restricted 1.4c2 F:unil Dwelling
c� ��C LGY 9d bl Mason
Cityi Town,State,fit' RC Rootin Coverin
WS window and 51d111
SF Solid Fuel Burning Appliances
71/ 1 Insulation
:e Email address D Demolition
----�--
T, c hone
5.2 Registered Home Improvement Contractor(HI 111C Registration Number Expiration Date
HIC Cunp:my Name or 111C Registrant Name
Email address
No.and Street
Tele hone
Cit /Town,State,ZIP
SECTION 6:WORKERS' CONIPENSAT[ON INSURANCE AFFIDAVIT(M.G.L.C. 152.§ re to provide
,
Workers Compensation Insurance affidavit must be completed and submittedwith this application. Failure to provide
this affidavit will result in the denial of the Issuance of the buildingpermit.
Signed Affidavit Attached? Yes .....ER ❑
No...........❑
SECTION 7a:AWNER AUTHORIZATION TO BE.COMPLETED W HEN
OWNER'S AGENT OR CONTRACTOR APPLIES FOR BUILDING PERMIT
t,as Owner of the subject property,hereby authorize
t9 act on my behalf,in all matters relative to work authorized by this building permit application.
Date
Print Owner's Name(Electronic Signatum)
SECTION 7b:OWNER'OR AUTHORIZED AGENT DECLARATION
fly entering my name below,I hereby attest under the pains and penalties of perjury that all of the information
n is true and accurate to the best of my knowledge and understanding.
con dint ' ❑ kcatio
ate
Pr i hvnc s or thorized Agent's Name(Elecuunie Signauire)
NOTES:
I. An Owner who obtains a building permit to do his/her own work,or) owner will not havverires an access t tithe arbitration trlctor
(not registered in the Home Improvement Contractor(H1C)Program)rtant ,
program or y`1ata`ttylnforl oilmlt�'tion on he Construction other
upervisor Licefnse can be fo found matlon on the atC Program� y 1,o be at
2. When substantial work is planned,provide the info(including garage
Icludinggarage finished basement/attics,decks or porch)
"Total floor area(sq. ft.) Habitable room count
Gross living area(sq. ft.) Number of bedrooms
Number of fireplaces Number of half/baths
Number of bathrooms Number of decks/porches _
Type of heating system Enclosed_--___.—_Open
Type of cooling system
3" "Total Project Square Footage"may be substituted for"Total Project Cost"
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onstructiiin Supen�isor Sandards`
License: CS-064669
CAETgHpFODE ¢'
70 SUMMER ST r
Stoneham RA 02780 r _ -
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Jy Commissioner ExPiration
0216si2ois-�
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<��. .r* �e�m�niteane�ea�ire p�LJr r/(aaaacluye �
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ME.IMPROVEMENT CONTRACTOR
t„ istration 1007695 F .'x TYPE>-
w xpiratlon 6i22t a .,,; DBA
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G 8 GCONSTRUCTION
- Gaetano Fodera
70 SUMMEii SMEET � r,-„• Cs'- ' � a '� -�,