4 PARLEE ST - BUILDING INSPECTION (2) a The Coin monwealthor Massachusetts RECE N1C
Board of Building Regulations anl�IQ��Np1 SCR CITY OF
4�f Massachusetts State Building Cod , 0 GMR SALEM
c+(` PRevi.reJ ,for
20i l
Building Permit Application To Construct, Repair, R�104)Memolish a
One-or Two-Family Dwelling
This Section For Official Use Only
Building Permit Number: Date Applied
uilding Ot7icial(Print Nmne) Signature B Date
SECTION I:SITE INFORMATION
LIP tperty Address• 1.2 Assessors Map& Parcel Numbers
4 �ar lei S-i ree-t
I.I a Is this an accepted street?yes no Map Number Parcel Number
1.3 Zoning Information: 1.4 Property Dimensions:
Toning District Proposed Use Lot Area(sq fQ Frontage(11)
1.5 Building Setbacks(ft)
Front Yard Side Yards Rear Yard
Required Provided Required71��Iood
d Required Provided
1.6 Wat r Supply:(NI.G.Lc.40,§5•t) 1.7 Flood 'Lone 1.9 Sewage Disposal System:
Public tt� Privnle❑ Zone: _ Oe? Municipal ❑ On site dislws:d system ❑
CSECTION2: PROERSHIP(
� Owner'o'Record:
S�(Jen , tyl 43 01970
N:unc cc�},,nnt) r' N mU>1 r� City.State.ZIP
97r�7t{q CCSwrn��a/-eom
No.and Street "telephone Einad Address
SECTION 3: DESCRIP,r10N OF PROPOSED WORK'(check all that apply)
New Construction ❑ Existing Building❑ Owner-Occupied ❑ Repairs(s) ❑ Alteration(s) El Addition ❑
Demolition ❑ Accessory Bldg. ❑ Number of Units_ Other ❑ Specity:
Brief Description of Proposed Work`: a t f t
- I!
SECTION 4: ESTINL\"rF.D CONSTRUCTION COSTS
Item Estimated Costs: Of Use On
Labor "trials Only
L Building $ r . �j I. Building Permit Fee: $ Indicate how fee is determined:
2. Electrical $ ❑Standard City/town Application Fee
v ❑Total Project Cost'(Item 6)s multiplier x _
44. Plumbing $ 2, Other Fees: `—'r
. Mechanical (IIVAC) .$ C> List:
TMechanical—(Fire
Suppression) Total All Fees: S_
.�f � J Check No. ___Check Amount:--Cash Amount:
6.Total Project Cost $ �. i� ❑ Paid in Full ❑Outstanding Balance Due:
Sb�➢J 1 TD 17laR�� Si �o t Z�
- 1
SECTION 5: CONSTRUCTION SERVICES
5.1 Construction Su',pervis'or.Licei se(CSL)
'A'Wit'/p?J1`l:. t
License Number Expiration Date
Name of CSL Holder-{ L7
�1A :"ram •� List CSL Type(see below)
No.and Street Type Description
U Unrestricted(Buildin s up to 35,000 cu. ft.)
R Restricted 1&2 FamilyDwelling
CitylPown,State,ZIP NI Mason
ry
RC Roofing Covering
WS Window and Siding
SF Solid Fuel Burning Appliances
I Insulation
'Pole hone Email address D Demolition
5.2 Registered Home Improvement Contractor(HIC)
HIC Registration Number Expiration Date
I IIC Company Name or HIC Registr:ml Name ,
No.and Street Email address
City/Town,State,ZIP Telephone
SECTION 6: WORKERS'CONIPENSATION 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
I, 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) Outs
SECTION 7b: OWNEW 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 applic [ion is true and accurate to the best of my knowledge and understanding.
�✓VY3��i�t��� 3 �
P nt Owner's or Authorized Ageni s Name(Electronic Signature) Da e
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.nrtss.eov/oca Information on the Construction Supervisor License can'be found at www.masS.eovAlns
2. When substantial work is planned,provide the information below:
Total floor area(sq. It.) _(including garage, finished basement/attics,decks or porch)
Gross living area(sq. 11.) Habitable room count
Number of fireplaces Number of bedrooms _
Number of bathrooms _ Number of halt/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"
JP Morgan&Company Real Estate Appraisers
Borrower:Carmen J.Munroe&Adam J.Schroeder File No.: MBCB22675
Property Address:4 Pates,Street Case No
City:Salem State: MA Zip:01970
Lender:The Beverly Cooperative Bank
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Subject Alternate Front View Subject Alternate Rear View
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Subject Alternate Street View Subject Aerial Photo
Source:Bing Maps
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Subject Kitchen Subject Upper Level Bath
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