50 ORCHARD ST - BUILDING INSPECTION (3) I'lie C'onmmonsveallh of Massachusclls
Board oI'Building Regulations and Standards CI'I')' OF
klassachusetts State Building Code, 7SO CNIR
DDDD Building Permit Application To Construct. Repair. Renovate Or in a
One.orrnvPionill Duellinq
This Section For Olrcial Use it
Building Permit Number: Dale Applicd:
t- IuilJiny 011icial(Frint N,une) Siynaurc Date
SECTION I:SITE INFORIIIA ION
o operty Addres�ct�n0� OLINtap
1.2 Asseswn Slap di Parcel Numbers
f' I.la Is this an accepted street? es no Number Parcel Numhcr
1.3 Zoning Information: 1.4 Property Dlmenslons:
/oning District I'mpuseJ(lW Lot Area Isq I)) Frontage(II)
I.3 BuIlJlno Setbacks(R)
Front Yard Side Ywds Rear Yard
Required 14uvidevt Required Provided Required I'roviJnl
1.6 Water Supply:(M.G.1.e. tU,§!a) 1.7 Flood Zone Informalion: 1.3 Sewage Disposal System:
R:blie O Privute O Zone: _ Outside Flood Zune?Check if cs(3 I Municipal O On site disposal s)star O
SECTION1. PROPERTY OWNERSHIP'
2.1 Owner'of Records
Mans(Print) city.state.ZIP
No.and Street relephone Errtuil Address
SECTION J: DESCRIPTION OF PROPOSED WORK'(check all that apply)
New Construction❑ Existing Building O Owner-Occupied O I Repairsls) O I Allerallon(s) ❑ 1 Addition (03
Demolition O Accessory Bldg.❑ Number of Units_ Other O .Specify:
Brief Descript' of Proposed
SECTION 4: ESTIJIATED CONSTRUCTION COSTS
I(em Estimated Costs: Ofliclal Use Only
i 1.ahor;red .\laterials)
I. Building S 1. Building Permit Fee: S Indicate how lee is determined:
'. clec(rical S O Standard City!Tu%m Application Fee
❑Total Project Cost'(Item 6)x multiplier _.. x
I !- I'lumhing S 2. Other Fees: S_
I a. \IvOmnical ill\ \('I S List:
�u +ressiunt Rmd \it Fees: S_..--_---- —
(hed. No. ( heck Amomil: l'aoh \mount:
t. Tulin Pnsjacl Cuvt S ( LQCf 0 P.dd in Full-- ❑[)utstanding 11.1l.mce Due:
St.'('"IJON S: ('ONS'1'RUCTION SERVICTS
t.l Cunstructimt Supers isur Liccuse(C'SL) L{- 1� �� i
I Icen.se Numhcr I �pirallau I)ulc
V;une of 01. I Iuldcr I L.I('S(. r)Pe oce heioa)
__�_�__ Description
Na .uni]trccl (I I1nreitrieleJ I lit"IditI s 00 10 35,111111❑I. 11
Halrieted 1C2 Famil Dtlellin
Cil\i fart n,$I:ne,LIP \I ••\Insum
RC Roolin Uncrin
µ'S IN indow.Ind sidin
SF Sulid Fuel Iluming Appliwtces
@'7 S C L-L 0 0. 1 h»IJalinn
1'elc huau Finail AtImm U Demolition
51 Registered Ilona Improvement Contractor(HIC) ( y I le S,Q R-1— 00
IIIC Registration Numher F.\Piralian Dute
' IIIC'Cumpwry Name nr IIIC'Registmm Nanw
U.and Street Etrull address
City/Town.State ZIP felt hone
SECTION 6:WORKERS'COMPENSATION INSURANCE AFFIDAVIT(M.G.L e. 157.1 33C(6))
Workers Compensation Insurance afFldavit 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..........a No O
SECTION 7m. OWNER AUTHORIZATION TO BE COMPLETED WHEN
OWNER'S AGENT OR CONTRACTOR APPLIES FOR BUILDING PERMIT
I,as Owner of the subject property,hereby authorize \ /— C,-- 1� V eve,\L -C \
to act on my behalf,in all matters relative to work authorized by this building permit application.
Print Utmer's Nwme(Elect tic Sig rc) Data
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 informntion
contained in this application is true and accurate to the best of my knowledge and understanding.
I'rinl Uwner'i nr:\ulhurinJ Apunt'+Nunes 1fleclnntiu Signature) Data
NOTES:
7MO\"ierer t\ho obtains a building permit to do his her own work,oran owner\vho hiresan unregistered cuntmctur
istered in the Hume Improvement Contractur(HIC) Program).will t nhave access to the arbitration
ur guarumy fund under M.G.L.c. 1 J?.\. Gthcr important information on the HIC Program can be round at
L. n . , I Information on the Cunstruction Super\isor License can be foundat tttttt illbstantial work is planned,pru\ide the information below:
ea tt+ ill ______I including garage, linished basement ottics.decks or porch)
fr ii g.trea Iiti. It.I .____.. flabimble roum count
\umber of lireplaccs .. ... ._._.. Number of hedrounu _ . .
\um herofhathrooms . . . . . \umber of halfhaths
I\pc o(heuting i)dcm \umher ol'Jecks porches
i'\pe,tt cooilllg i1♦relit
Fnclu\eJ Open
1. "l.n.tl Projeel S,111:1N I',h,IJVV III;1\ be iuh\tittucd 11or total Project (otl"
r0TelSttl Page No. of Pages
Semper Fi Builders
Jeff Turner
57 Riverview Ave.,Danvers, Ma 01923
feall semperfi8uilders@corrn:ast.net
978-5904 019
PROPOSAL SUBMITTED TO PHONE DATE
VI
{ l lip °47 S`i Li t(o
STREET [� JOB NAME�r
CITY,STATE and ZIP CODE JOB LOCATION
% .e. a
ARCHITECT DATE OF PLANS JOB PHONE
We hereby submit specifications and estimates for:
1. N e . pvc Co «� 3 �4�
�. Q1 VQ6\ r b�
1D-e4' rY �,('�f Cj�.n�. �+ 7i 13� �'L4� 'C�sr c� V_0()S, .
Wr proPOSP hereby to furnish material and labor— complete in accordance with above specifications, for
the sum of:
v k 0 u Q-0--r, k\-L\V" cry dollars($
Payment to be made as follows:
_ All material is guaranteed to be as specified. All work to be completed in a workmanlike
manner according to standard practices.Any alteration or deviation from above specifications Authorized
involving extra costs will be executed only upon written orders, and will become an extra Signature
charge over and above the estimate. All agreements contingent upon strikes, accidents V
or delays beyond our control.Owner to carry fire, tornado and other necessary insurance. Note:This proposal may be
Our workers are fully covered by Workman's Compensation Insurance. withdrawn by us if not accepted within days.
�ccept-nce ut proposal —The above prices, specifications
and conditions are satisfactory and are hereby accepted. You are authorized Signature
to do the work as specified. Payment will be made as outlined above.
Date of Acceptance: Signature