3 PARALLEL ST - BUILD NEW, SINGLE FAM HOME O The Commonwealth of Massachu=Dcmolisha
l L Board of Building Regulations and S
�. �� Massachusetts State Building Cafe, 780 CM
` Building Permit Application To Construct, Repair, Rloonew
One- or T -Fijindv Duelling
Th Sect on For Official se Only
Building Permit N miser: ale ied:
Signature: "�"
Building Comrrtusto rl Inspector of Bwl t Date
SEC litVIN 1:SITE INFORMATION
L1 Property Address: 1.2 Assessors Mop& Parcel Number
3 pg .�t Stti<cr 7-S 2W
1.1 a Is this an accepted street:'yes no Map Number Parcel Number
IJ Zoning Information: 1.4 Property Dimension', 3 •S
2-Z 2r<aU ,at_ ZQ o
Zoning District Proposed Use Lot Ann(sq n) Frontage ItU
1.5 BuildWIft)
Side Yards Rear Yard
Required Required Provided Required Provided
1.6 Water .13a) 1.7 Flood Zone information: 1.8 Sewage Disposal System:
Zone: _ Outside Flood Zone? Municipal O On sitePublic OCheck if sM
SECTION2: PROPERTY OWNERSHIP'
2.1 Owner'of Record:
Name IPsint Addrew for Service:
Signature Telephone
SECTION J: DESCRIPTION OF PROPOSED WORK'(cheek AN that apply)
New Cons Clio" Existing Building O Owner-Occupied O Repeirs(s) O Alteration(s) O Addition O
Demolition O 1 Accessory Bldg.O Number of Units_ Other O Specify:
Brief Description of Proposed Work':
SECTION 4:ESTIMATED CONSTRUCTION COSTS
Estimated Costs: Offldal Use Only
Item Labor and Materials
I. Building f po 6 I. Building Permit Fee: f Indicate how fee is determined:
O Standard City/Town Application Fee
2 Electrical S 6a0 O Total Project Cost'(Item 6)x multiplier a
I Plumbing S J0 (3 2. Other Fees: S
a. Mechanical IHVAC) It 000 List:
s Mechanical tFire S Total All Fees: S
Su res%ion
Check No. _Check Amount: Cash Amount:_
A Total Project Cosh S 6�,000 p Paid in Full O Outstanding Balance Due'
`7/� , o0
SECTION 3: CONSTRUCTION SERVICES
5.1 Licensed Construction Supervisor(CSL) GS L10q'76
i Y
License.Number Evpuauon Ogre
.vyee of CSL- fielder o L-sr('SL Type(see heluw)
AdJrexa Tvoc Descrr ti
U Unrestricted(up Ft to 17,000 Cu. Ft.
R Restricted l Al Family Dwelling
Srana�rim �� �� .H %fasonry Only
JJ UU JJ RC Residential litooff Covering
Telephone W S Residential Window and Sidinjif
SF Residential Solid Fuel Burning Appliance Installation
D Residential Demolition
3.2 Registered Home mp vemeotContractor(HIC) fct
�/77�
HIC compapany N me or HIC edistram Iiarnr � ` Regtatiauo Number
� ' U
Addns Ti
G g Eapintion Dale
Signature Telephone I i
SECTION 6:WORKERS'COMPENSATION INSURANCE AFFIDAVIT(M.G.L.e. 137.J ISC(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 AMdavitAttachesl7 Yes..........0, No...........0
SECTION 7m:OWNER AUTHORIZATION TO BE COMPLETED WHEN
OWNER'S AGENT OR CONTRACTOR APPLIES FOR BUILDING PERMIT
1, 5 re wxj P Uv,3e !!4 as Owner of the subject property hereby
authorize lW A e eLea AC A+4Scisj to act on my behalf,in all matters
relative to work authorized by this building permit application.
2-1
Si annrofOwner Date—r
SE ION 7b:OnW/NER!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.,, ��gg
vUlli✓ 1%S�>/1
Print Name
Signature of Owner or Authorized Agent Date
(Signed under the gains and penalties or
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 1 HIC)Program).will M have access to the arbitration
program or guaranty fund under M.G.L. c. 1 J2A. Other important information on the HIC Program and
Construction Supervisor Licensing(CSL)can be found in 780 CMR Regulations 110,R6 and 110.RS,respectively.
2. When substantial work is planned•provide the information below-
Total Goon arcs(Sq. F1) (including garage, finished basement/anics,decks or porch)
Gross living area(Sq. Ft.) Habitable room count
,Number of fireplaces Vumber of bedrooms
Number of bathrooms Number of halfbaths
Tvpe of heating system Number of decks/porches
Typeufcoolingsystem Enclosed Open
1 "Total Project Square Footage'may he.uhdrtuted for 'Total Project Cost'
CITY OF SALEM
ROUTING SLIP
New Construction h
Certificate of Occupancy
1.
LOCATION 3 Pra / DATE
ASSESSORS DATE
93 Washington St.
CITY CLERK DATE 10
93 Washington St.
PUBLIC SERVI DATE
120 Washington St.
WATER DATE
120 Washington St. Adv
CROSS CONNECTION DATE
5 Jefferson Ave
PLANNING oliDe W_XDATE I
120 Washington St.
CONSERVATION DATE
120 Washington St.
ELECTRICAL -DATE 0 O
48 Lafayette
FIRE PREVENTIONO DATE G
29 Fort Avenue
HEALTH DATE
120 Washington St.
BUILDING INSPECTOR DATE
120 Washington St.
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