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5 WITCHCRAFT RD - BPA ADDITION
�/�S°' G� I �SS „ r � CheCommonwealthofMassachusetts RECt1�!-p , ��;sPEcr�o��„ � T QF r � Board of DuilJing Regulations and Standards L �ER SA�.£tZl r i�/ Nlassachusetts State Building Code, 780 CMR Revised.�lur 2011 0(; Building Permit Application To Construct, Repair, Renovate O�r��l�sl�i� P 12: 4 3� r One-oi Tivo-Fanrly Dwelling � This Section FocO�cial Use Onlp .. - ` � 6uilJing Permit Number: Dn Appliedt � ,�,,,s -�.� - ` )� �'/ �.�,,L ��uilJingOtticiul(PrintN;une). --. Signature•: �. . � Date . � SECTION 1:SITE INFOR��IATION` ' I.I oper,�Y AJdres"s/: 1.2 Asseesoro b(np&Pnrcel Numben ... . � W%T(�'L^/rs� . . I.I a Is this an acce ted street?yes_ no M1fap Number '� P�rcel Number 1.1 'Loning Informntion: 1.4 Property Dlmensions: "Luning Disuict _. ProposeJ Use Lol'Area(sy ft) - Frontage(Il) - � 1.5 BuilJing Setbncks(ft) Front Yard . . .. .. �SiJe Ymds � Rear YarJ . ReyuireJ Providnl Reyuired� � � ProviJed- Required � ' ProviJed t.6�Vnter Supply:(M.G.L c.d0,§SJ) 1.7 Flood Zone Informution: 1.8 Sewnge Disposni System: Zune: _ Outside flood Zone7 Munioipd O On site disposol system O � Public 0 Private❑ Check if es0 SECTIOIVZ: PROPERTYO�VNERSHIP" 2,! Owner�of Rc y•ord: �•_/Q� //.sg ��S �O �2��1 ( s, !'l( PCict 7S� /"� t3 me(Print) . City.State,ZIP � . 1,•�irG�ivs��� 7TS�'1755 /%r„r�;�,e��:73 �J�:h�;(. o� No.:md Stn:et Telephone Email A�Jnrtss SECT[ON 3: DESCRIPTION OF PROPOSED\VORKi(check nll that apply) � �New Constniction❑ Ezisting Building❑ OwnerOccupied ❑ Repairs(s) O Alteration(s) ❑ Addition ❑ Demolition � ❑ Accessory Bldg.❑ Number of Units_ Other ❑ Specify: � � �rinf Description of Proposed�Vork': � - � �U , SECTION�:ESTIDIATED CONSTRUCT[ON COSTff ��� � Estimated Costs: Ofticirl Use Only Labur aud�laterials)� - � � ` - � I. �uilding S I. Building Permit Fbe:$ Indicate how fee is JetermineJ: �Standard City/Tawn Application Fea 2. Electrical � p Total Project Cost�(Irem 6)x multiplier s }, p�umbing - 5 3�Qther Fees: 5 � d. �fcch;mic�l (HVAC) S LisC 5. �\fach�nical (Fire ,� '��tal All Fcas:S � Su rcssiun) �. Clieck No.._Check AmounC Cash Amount: G Totul I'roject CusF: .'S ��O� ❑p;�id in Full ❑OutshnJiu�6al:�nce Due: M�Ai i_e,-C� i O �2c� V SECTION 5: CONS"PRUCPION SERV(CES S.t Construction Supcivisor License(CSL) � � - License Number Expimtion Dale- Name of CSL flulder List CSL'Pype(see below) � -Type - � � :� � � � �- Descriplion . No. ;mJ Strect � �� � 0 UnreslricMd DuilJin u -to 35.000 cu. It. R Restricted I&2 F:unil Dwellin Cilyll�a�m.Stale,"LIP M Mnso � RC Roolin Cuvcrin WS WindowandSiJin � ' SF Soiid Fuel Buming Appliances 1 Insulation Tde hone Email addrcss D Demolition 5.2 Registered ktome Improvement Contracror(HIC) � HIC RugisUation Number Espirution D:ite � I IIC Cump:my Nmne or f11C Regis�ront Name � Nu. and Sveet - Emuil udJress Cit /Town State ZIP Tele hona SECT[ON 6�WORKERS'COMPENSATfON INSURANCE�FFIDAVIT(M.C.L:c.152.§25C(�p; Workers Compensation Insurance nftiduvit must be completed and submitted with this application. Failure to provide Ihis aRidavit will result in the denial oFthe Is4uance of the building permit Signed Atfidavit Attnched? Yes ..........❑ No...........O , SECTION 7up OWNERAUTHORI2AT[ON:TO BE COMPLETED.)VHEN ' OWNER'S AGENT OR CONT[tAC7'OR APPW E9'FOR BU[LD[NG.PERM1IIT i,ns Owner of the subject property,hereby nuthorize - t9 nct on my behalf,in all matters relative to work authorized by this building permit application. Prinl Owncr's Name(Electronic Signalure) � . Dute SECTION 7b:OWNER�ORAUTHORIZED AGENT DECLARATION Oy entaring my name below, 1 hereby attest under the puins and pennities of perjury that all of the information contained in this npplication is true and acwrute ro the best of my knowledge nnd understanding. /�S�h �'a(��'UPq� I/7-�� �bS 'Print Ownar's or Authorizcd Agent's Namc(Elcctrumc Signature) Date NOTES: I. An Owner who obtains a building permit to do his/her own work,or an owner who hires an wvegisrered contracror ., ___ ____(not registered in the Home Improvement Cuntrnctor(HIC) Progmm};will n�t have access ro lhe nrbitmtion �-- � -—•---- — — � - progtam or guaranty Fund under h1.O.L.c. IJ2A.Other important information on the NIC-Piogram ca`n 6e faunU at-" -- ""- - ��w.v mas,eo�:'oca Information un the Construction Supervisor License can be.f'ounJ at�v�ow.ma,,.�so�%'Jos . � 2. \Vhen substantial work is pl:uined,provide the inf'ormation below: 'Potai tluor area(sq. RJ �_(includins g�rage, tinished basementlattics,decks or porch) Gross living area(sy. ft.) � Habitable room cow�t Numberof tireplaces Number of 6edrooms vumber uF bathroums Number uf 6alf/bnths TYP�uf I�e�ting system NumberoFdecks/porches ��YPeufcoulingsystem �uciosed� Open 3. "Toial Pruject Syu;ue Fum:�se"may be,ubstitureJ I'ur"Tutd Project Cost" . �� ��'n � � . . . . � � . � � . �. � . � .. l�17� 3.� � �n��o� �nnd �n�Do� `a��o��n�o�� _Bn�o : Rrofessional Land Surveyors B GiJil Engineers ESSEX SURVEY SERVICE \ 1958 - 1988 OSBORN PALMER 7911 - 1970 ;: _ , BRADFORD 8 WEED . 1885 - 1972 PLOT PLAN OF: LAND � HS( LOCATID IN: : N'onr�A.✓ �7/12�7� MASS, . �S� �A/SSC 2 f� �.�� �Q� . ���1 L-�= /�r s- a�_ j ;l�c��Sn , � � �\ � I �> � �, � � � ( T�' � ' w � � - � S��/7� � � � � L LI � � � .. iQ1/G��1 — I �ODm�.� ,� _ , _ - po p'— ; i- M t . . . . . . 6Fto�r. -.,� -.r�� . � � . . . . ' , �t.�rS�II✓�LrtL/ a� ' �3 ` i ' '!f'✓�J N!✓ ' ' . . . � . . . .. . . - - . . � . . . . � . ' . .. ,. ��� '9I'' �r � ` I hereby certify to �/•_�SA�G/�� ' . �lr���Gi��;�r �D�{'�t7 �Gi'��J'{:o /��8�'CG/� that the buildings are located on fhe ground as shown l/ - � .. . � � � ' �:��:.OF ,�qvsry4r; , �. sc,�: / = 9p cH r� . . � Y' � � .� - _ DATE: DG�QIE�Z ZG 2G/S u,� �. rn '; -� � � � d„ � No 31317 � � �� � REFERENCE: . BK PG Christopher R �1e �,�,� 13�.'-'7 �'�� n'> t� "u<� . - � - � . � . ' . � . -bb�elv6W�n�3' � � 104 LOWELL STREET ' PEABODY, MASS. 01960 - . , . � � � . - - . (978)531��-8121 ��� � . . . . � . . . . - .. . . . . . . . . . . . FAX`. (9781531-5920. . . . . . �, � �. . ... . . , �. ` _�/ __---------------_____ m��_._..__. _T_.._.______� _ ...._ � ...�._._. .. �� _--._. _.�__� ._ ..— - ...,_____ ._ _,... . , �.__�.�. �_^__ . /� i � �� � � � ° � ;r � ? �. � � .r . ,,,. � ' .., . , . , . , �% , /j.. ..:�`'� �.. ,. i ,.." ��., � " . �. . �./" __l���.Unt.,. .��l�i'�1 � ` . , J J y ,.. „.. ' . . /' . � '� . '\ �./� . � /� � .. ..� � . � �(\I (.lUO�'j J,." 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