5 PAUL AVE - BUILDING INSPECTION (3) t �
The Commonwealth of Massachusetts
Board ul'Building Regulations and Standards CITY
Massachusetts State Building C'Code, 780 MR, 7'edition OF SALEM
Rrt•i.rrd01AV rvr
Building Permit Application To Construct. Rep ir, Renovate Or Demolish a �• =rRly
O - n rives-Family a ing
Thks Section FflfOfricial Use Only
Building Permit Number: Date Applied: 0 le';V11
I C�
Signature:
Building Cum issioned Inspector uildirip Dale
S ION 1: SITE INFORMATION
1.1 Property Address: 1.2 Asstsson Map d1 Parcel Numbers
AM
I.la Is this an accepted street?yes no Map Numbs Parcel Number
IJ Zoning Information: 1.4 Property Dimensions:
Zuning District Proposed Use Lol Amo(sq 11) Frontage(11)
1.5 Building Setbacks(R)
From Yard Side Yards Rev Yard
Required Provided Required Provided Required Pmvided
1.6 Water Supply:(M.G.L c.40•§54) 1.7 Flood Zone Information: 1.8 Sewage Disposal System:
Public❑ Private❑ Zone: _ Outside Flood Zone? Municipal❑ On site disposal system ❑
Check if yesO
SECTION 2: PROPERTY OWNERSHIP'
2.1 Owne.0ofRecord: $ALU4T70A) A "Oci!![T-Cp
(aT' scram Ml� A1€L 5 /±Uz- 1 J&
Nam (Print) Aaarostfor service: r
4`7A --1Liq -- S! A1
Signature Telephone
SECTION l: DESCRIPTION OF PROPOSED WORK'(cheep aU that apply)
New Construction❑ Existing Building❑ Owner-Occupied ❑ 1 Repairs(s) ❑ 1 Ahcration(s) ❑ Addition ❑
Demolition ❑ Accessory Bldg.❑ Number of Unis I Other ❑ Specify:
Brief Description of Proposed Work': e u 'Lb � tP T. D�cC.IC. (Z/4 r C.i 6J6- t
S�at,eS F0o77�6-5. �o5zs. ,� f�c !TL Ici.�� L4/:. vs
Lilf-.4hf� G�64✓t21rf sG F2nC r r-� .><� C _ .50 .�0�7�
SECTION 4: ESTIMATED CONSTRUCTION COSTS
Item Estimated Costs: 011lelal Use Only
Labor and Materials
I. Building is /,.57—Zs� o° I. Building Permit Fee:f Indicate how lee is determined:
2. Electrical S ❑Standard City/Town Application Fee
❑Total Project Cost'l Item 6)x multiplier x
3. Plumbing S 2. Other Fen: S
4. Mechanical (IIVAC) $ List:
5. Mechanical (Fire r r
'Suppression) S Total All Fees:S_
no Check No. Check ALI: Cash Amount:6. Total Project Cost: s �O ❑Paid in Full ❑Outstanding Balance Due:
N�V /)
SECTIONS: CONSTRUCTION SERVICES
5,1 Licensed Construction Supervisor(CSL) e S f0 /9,o<�— Ll Z 20f 2
n���� � Z Q �v� r2 I.icerue Numbs I: unto Irate
Name of C'Sl.• 1144lcr Lill C 51.Type(see below)
L r lks ription
2 U llnresuicteJ u to 35.000 Cu.ft.
R arnily Dwelling
. Isinalure f M me2m Only
!J22 �7 ZO�/d/ RC Residenial Raulin C'overin
f WS Residentiat Window and Sidin
fclephsme
SF Residential Solid Fuel Burning Appliance installation
D I Residential Demolition
5.2 Registered no )
CGwl � � /5 T Z82��
Registration Number
I ll,C pan Name ur lIIC Registrant Name
„ 3 7 MC/
,�
g y g 7�0 D/D/ Eapi tion Date
Siraiure Telephone
SECTION 6: WORKERS'COMPENSATION INSURANCE AFFIDAVIT(M.G.L.e. IS2./ 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 IssuaneSpfte building permit.
Signed Affidavit Attached? Yes .......... No...........O
SECTION 7a:OWNER AUTHORIZATION TO BE COMPLETED WHEN
OWNER'S AGENT OR CONTRACTOR APPLIES FOR BUILDING PERMIT
1 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.
Si um of Owner Dote
SECTION 7b: OWNER'OR AUTHORIZED AGENT DECLARATION
as Owner or Authorized Agent hereby declare
that the statements Ad information on the foregoing application are We and accurate,to the best of my knowledge and
Ix�al S (V i CEOOoe
Signature of owner or Autiforized Agent - Dat
(Situbcd under the pains and penalties of 'u
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 no 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 790 CMR Regulations I IO.R6 and I IO.R7,respectively.
2. When substantial work is planned,provide the information below:
Total floors area(Sq.Ft.) (including garage.finished basement/attics,decks or porch)
Gross living area(Sq.Ft.) habitable room count
Number of fireplaces Number of bedrooms
Number of bathrooms Number of half/baths
Type of heating system. Number of decks/porches
Type of cooling system Enclosed Open
). "Total Project Square Footage"may be substituted for"Tolal Project Cost"