2 SAVONA ST - BUILDING INSPECTION (2) 7 The C'onmmonwelllh of Ma55aCh LlSCltS
hoard of Building Regulations and Standards CITY OF
Massachusetts State Building Code, 780 CMR SALL I
Building Permit Application To Construct, Repair. Renovate Or Demolish a
One- or Two -Fin di Du ellinl;
This Section For icli l Use Only
Building Permit Number: ale Applicd:
Building 011icial(Print Nano Signature .I
SECTION 1:SITE INFORMATION
.I Pro operry Address* -f 1.2 Assessors 11,11ap Rr Parcel Numbers
I.la Is this an accepted street?yes / no bL,p Nuinher Purcd NumfKr
1.3 Zoning Information: 1.4 Property Dimensions:
Lonill District Proposed Usc Lot Area(sq It) Frontage 01)
1.5 Building Setbacks(h)
Front Yard Side Yards Rear Yard
Required Provided Required provided Required Provided
1.6 Water Supply:( 1.c.a0, §S4) 1.7 Flood Zone Information: 1.8 Sewage Disposal System:
Public❑ Private❑ Zone: _ Outside Flood Zone?
Check if es❑ Municipal❑ On site disposal system ❑
SECTION2: PROPERTY OWNERSHIP'
2. Own t f3ecord• oleo
70
N re(Print) Uty. late.LIP
- s�l/o•v f pl -
No,and Street Telephone 6nuil Address
SECTION J: DESCRIPTION OF PROPOSED WORK'(check all that apply)
New Construction ❑ Existing Building❑ Owner-Occupied ❑ Repairs(s) ❑ 1 Alteration(s) ❑ Addition ❑
Demolition ❑ Accessory Bldg.❑ Number of Units_ Other ❑ Specify:
Brief Description of Proposed \Vork`:
4p i
SECTION 4: ESTIMATED CONSTRUCTION COSTS
Ilan Estimated Costs: Official Use Only(Labor and N laterials) y
I. Building g I. Building Permit Fee: E Indicate how fee is determined:
12. Electrical g ❑Standard City/Town Application Fee
❑Total Project Cost'(Item 6)x multiplier _ _ x
i. l lurching 5 ?. Other Fees: S — //- -
J. Nlecha..."1 ill\':\('1 4 List:_
S. N leehanical I Fire --- ----ill'----------__.v
.tie,uessionl S Total All Fees:
.7oOA O d ❑Check No. Check Amount: Cush Alliuunt:
a. Total Project Cost: i --- --
r Paid in Full ❑Oulsl:mding B—aL-
vice Dec;
SF.CTMN 5: CONSTRUCTION SF.RVICF.S
5.1 Construction Supervisor License(USIA
License Number Fgliruion Date
Nuutc of CSI. I Inlder
List CSI.1)pc(see heluwl
.B PC Description
No. and Strect
t i t 4vcstricted(lluildin p uO to 35,000 ol. tt.l
R Restricted LC''_Family Dwcllin
Citci town,.slate.LIP ------- - M Ntawnry
RC Rtwfing Cuvcrin
-_—. WS window and Siding
SF Solid Fucl Burning Appliances
I Insulation
I cle hone I[nlail address D Demolition
5.2 Registered home Improvement Contractor(HIC)
I IIC Registration Number Fi piratiun Date
I IIC Compan) Nano or I IIC Registrant Numc
No. and Sucet L'mail address
City/Town. State,ZIP Telephone
SECTION 6:WORKERS'COMPENSATION INSURANCE AFFIDAVIT(M.G.L.c. 152.1 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 Nnne(Electronic Signature) Date
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 app 'catio is t ue and accurate to the best of my knowledge and understandingz/
uu K% er's�uthorired Agent's Name(Plectronic..Signawre) Dne
NOTES:
I. An Owner who obtains a building permit to do his,her own work,or an owner who hires an unregistered contractor
tnot registered in the Hume Improvement Contractor(HIC) Program),will no have access to the arbitration
program or guaranty fund under NI.G.L.c. 112A. Other important information on the HIC Program can be round at
MA", t 01.1 Infonn:uion on the Construction Supervisor License can be found at t sy nia„ 1 It',
i \Phan substantial work is planned, provide the information below;
Total fluor area(sq. ft.) _ t including garage, finished basementattics,decks or porch)
Gross living area I sy. tt.t _-- _ -_- ---- - _ habitable room count -
\tunlber of fireplaces..___ ._ _ _ - ...— Number of bedrooms
Nwnherol'hathroonu Numberufhalf'hadu
I)pcofheau'ng s)Stem _ NUMbO of decks, porches
-
-
I'peofcooIingsySwtn . . - - I?ncloscd _ - .))pen . .
1, "faUtl Project Square i'ooClgc-mas lie ,tlbslltuled tin' Total Project Cost-
l
CANERON BROS. INC. 848 P02 APR 2e '94 07:36
RECiSTRY:
O�
P` P TITLE REFERENCE: CERT, NO, 603s3
PLAN REFERENCE: j_•C,PLAN lVa0Z-8
SP` w/c�nr asa�s
J
N
Ib
573 57 z.
fj
1so.84 Z33
m
U1 �000
0 5r"R� 0
li7 an, 84,
STRE ET Note: The deck does not conform to th
minimum side yard setback. .It is exem
from violation enforcement action and
N,GL Cha . 40A Se tion 7.
This plan was not prepared from an instrument survey. MORTGAGE PLOT PLAN
Offsets and distances shown should not be used to
establish property lines. LOCATION Z SAVO N A S F.
This plan is intended for mortgage purposes only. 5ALEM MA'
I certify that the structure shown on this Plan SCALE: I ' 30� DATE: - 1 9-94
INAS in conformance with zoning setbacks
in effect at the time of construction, except deck. CERTIFIED TO:
(see note) — De Wo We Neal Ena lanJ
I I certify that the parcel shown isLyO Tlocated within
a Flood hazard area as depicted on HUD Flood Insurance Mo age- G--;erV 1 C'--5, 0C.
Rate Maps for Community No: Z5Q 1 bZ _