13 PARALLEL ST - BUILDING INSPECTION e
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The Commonwealth of MassachusetsBoard of Building Regulations and Standards Town of
Massachusetts State Building Code, 780 CMR, 7"edition Building Dept
Permit Application To Conswct. Repair, Renovate Or Demolish aOne- tar Tuu-funuh Duelling
This Section Fae ale Apt Ux Onlcc Date Applied: ?s• Q s t {�3• Ze I a use er/Inspector of Buildings Due
SECTION 1:SITE INFORMATION
Pro rt Addreu: 1.2 Assessors Map& Parcel Numbers
�I,OZ=P I 21� 0 1 3 2
1.I a Is this an accepted street'!yes 7 no Map Number Parcel Number
1.3 Zoninj Information: 1.4 Property Dimensions: 5 B t
ZoNng District Proposed Use La Area(sq R�) Frontage(fl)
1.5 Building Setbacks(R)
Front Yard Side Yards Rear Yard
Required Provided Required Provided Required Provided
1S' IY t0 to 3Y lout
1.6 Water Supply:(M.G.L c.e0,154) 1.7 Flood Zone Information: 1.8 Sewage Disposal System:
Zone: _ Outside Flood Zone?
Public� Private O Check if s� Municipal On site disposal system O
SECTION 2: PROPERTY OWNERSHIP'
2.1 Ownerl of SF bwecip Lore \h I4 5}a S+ S�
Name(Print) Address for Service:
�1'18- 1
Signature x Telephone
SECTION l: DESCRIPTION OF PROPOSED WORK'(check all that apply)
New Construction*d Existing Building❑ Owner-Occupied 0 1 Repairs(s) O 1 Alteration(s) O Addition O
[2Elecincal
molition O Accessory Bldg.O Number of Units_ Other O Specify:
f Description of Proposed Work':
SECTION 4: ESTIMATED CONSTRUCTION COSTS
Estimated Costs: Official Use Only
Labor and Materials)
uilding S 5 bpp 1. Building Permit Fee: S Indicate how fee is determined:
f O Standard City/Town Application Fee
tS� O Total Project Cost'(11em 6)x multiplier x
J Plumbing it pa o 2. Other Fees: S
3. Mechanical (HVAC) S .10.c, List:
I Mechanical (Fire S
Suppression)) Total All Fees: S
Check No. _Check Amount: Cash Amount:_
h Total Project Cost: S o210 aU 0 Paid in Full 0 Outstanding Balance Due:
t
SECTION !: CONSTRUCTION SERVICES
5.1 Licensed Construction Supervisor(CSL)
License Number Expiration Dam
N,yoe of CSL Itylder Lm CSL Type lAv W,uw)
s
[RDRtsidential
Description
Address
nrestricted u to 33,000 Cu. Ft.
estricted Ik2 FamilyDwelling
Sitrsitort ason Only
esidential Rooting Covering
Telephone esidential Window and Siding
esidential Solid Fuel Burnet Appliance Installation
Demolition
5.3 Registered Home Improvement Contractor(HIC) )c G 9 9
Pe'e�sev
HIC Company Name or HIC Registrant Name Registration Number
ITo in- w:srewY* s+erect 'PovAaah -01 '1 ( Zola .
Address
q'Ik- 1 S a— 24 3 S Expiration Date
Sign tiue Telephone
SECTION 6:WORKERS'COMPENSATION INSURANCE AFFIDAVIT(M.G.I. C. 152.1 2SC(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? Yea..........10 No...........0
SECTION 7a:OWNER AUTHORIZATION TO BE COMPLETED WHEN
OWNER'S AGENT OR CONTRACTOR APPLIES FOR BUILDING PERMIT
1, -SV96� 1p (Ave k1 as Owner of the subject property hereby
authorize PLIA ti9 t VbL, \;dw 5 to act on my behalf,in all matters
relative to work authorized by this building permit application.
r
f Owner Date
SECTION 7b:OWNEWOR AUTHORIZED AGENT DECLARATION
0 L6Jc � , as Owner or Authorized Agent hereby declare
tements and information on the foregoing application arc true and accurate, to the best of my knowledge and
tp
31 (Owner u orized Agent Dater the ains and nalties of r
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 gg have access to the arbitration
program or guaranty fund under M.G.L c. 142A. Other important information on the HIC Program and
Construction Supervisor Licensing(CSL)can be found in 780 CMR Regulations 110.R6 and 110.R3,respectively.
2. When substantial work is planned,provide the information below:
Total floors area(Sq. Ft l'I o !including garage, finished basemenVattics.decks or porch)
Gross living area(Sq. Ft.) 17 o v Habitable room count 6
Number of fireplaces t O Number of bedrooms 3
'umber of bathrooms ' y Number of halfbaths ! '
Tvpe of heating system '�A$ A Number of decky porches 2
Type of cooling system r� Enclosed Open . z .
1 "Total Project Square Footage'may he +uhstilumd for 'Tout Project Cost"
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CITY OF SALEM
ROUTING SLIP
New Construction
Certificate of Occupancy
LOCATION& 1461 .10- DATE 04 Of'
ASSESSORS Gtrl-rr DATE
93 Washington St.
CITY CLERK DATES/s,L�
93 Washington St.
PUBLIC SERVICE DATE 2 1 t A
4
120 Washington St.
WATER �J G�/`G '� DATE L7i /UtG l � .
120 Washington St.
CROSS CONNECTION DATE
5 Jefferson Ave
PLANNING DATE
DATE u D
120 Washington St. �—
CONSERVATION DATE L 11 10
120 Washington St.
ELECTRICAL DATE 6 C
48 Lafayette
FIRE PREVENTIONQ DATE Znlel6,9
29 Fort Avenue
HEALTH DATE
120 Washington St.
BUILDING INSPECTOR DATE
120 Washington St.