BP APP 17-27 J .�
� The Commonwealth of Massachusetts " )�q�t rr[ t g.=• .<
Board of Building Regulations and Standards
W Massachusetts State Building Code, 780 CMR SALEM
20 1 RJANed,VarA?1 3
Building Permit Application To Construct, Repair, Renovate Or Demolish a
One-or Two-Family Dwelling
This Section For Official Use Only
Building Permit Number: Date�kp'plied:
` Building Official(Print Name) Signature
SECTION 1:SITE INFORMATION
1 1.1 Property Address: 1.2 Assessors Map&Parcel Numbers
7 Day Avenue 32 0119-0
L l a Is this an accepted street?yes no Map Number Parcel Number
1.3 Zoning Information: 1.4 Property Dimensions:
Zoning District Proposed Use Lot Area(sq ft) Frontage(ft)
1.5 Building Setbacks(ft)
Front Yard Side Yards Rear Yard
Required Provided Required Provided Required Provided
1.6 Water Supply:(M.G.L c.401,§54) 1.7 Flood Zone Information: 1.8 Sewage Disposal System:
Public❑ Private❑ Zone: _ Outside Flood Zone? Municipal❑ On site disposal system ❑
Check if yes❑
SECTION 2: PROPERTY OWNERSHIP'
2.1 Owner'of Record:
Richard Gordon Salem MA 01970
Name(Print) City,State,ZIP
7 Day Avenue 978-498-4625
No.and Street Telephone Email Address
SECTION 3:DESCRIPTION OF PROPOSED WORKZ(check all that apply)
New Construction❑ Existing Building❑ Owner-Occupied ❑ Repairs(s) ❑ Alteration(s) ❑ Addition ❑
Demolition ❑ Accessory Bldg. ❑ Number of Units Other M Specify: Solar Installation
Brief Description of Proposed Work': 26-Silfab 30OW Panels 26-Enphase M250 Micro Inverters, 7.8 Kw Syste
SECTION 4: ESTIMATED CONSTRUCTION COSTS
Item Estimated Costs: Official Use Only
(Labor and Materials)
1.Building $ 23,420 1. Building Permit Fee: Indicate how fee is determined:
❑Standard City/Town Application Fee
2.Electrical $
10,000 ❑Total Project Cost (Item 6)x multiplier x
3.Plumbing $ 2. Other Fees: $
4.Mechanical (HVAC) $ List:
5.Mechanical (Fire $ Total All Fees:$
Sunoression)
Check No. Check Amount: Cash Amount:
6.Total Project Cost: $ 33,420 0 Paid in Full 0 Outstanding Balance Due:
SECTION 5: CONSTRUCTION SERVICES
5.1 Construction Supervisor License(CSL)
CS-108214 4/2/18
Eric Chartrand License Number Expiration Date
Name of CSL Holder
List CSL Type(see below) U
27 Sanborn Street
No.and Street Type Description
U Unrestricted(Buildings up to 35,000 cu.ft.)
Fitchburg MA 01970 R Restricted 1&2 Family Dwelling
City/Town,State,ZIP M Masonry
RC Roofing Covering
WS Window and Siding
SF Solid Fuel Burning Appliances
978-652-2680 ericchartrand@endlessmtnsolar.com I Insulation
Telephone Email address D Demolition
5.2 Registered Home Improvement Contractor(HIC)
174479 1/28/17
Endless Energy HIC Registration Number Expiration Date
HIC Company Name or HIC Registrant Name
288 Kidder Street jimlaskowski@endlessmtnsolar.com
No.and Street Email address
Wilkes Barre PA 18702 570-820-5990
Ci /Town,State,ZIP Telephone
SECTION 6:WORKERS'COMPENSATION 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 .......... IN No...........❑
SECTION 7a: OWNER AUTHORIZATION TO BE COMPLETED WHEN
OWNER'S AGENT OR CONTRACTOR APPLIES FOR BUILDING PERMIT
1,as Owner of the subject roperty,hereby authorize Endless Energy
to act on in alf,in atters relative to work authorized by this building permit application.
Print is a lectronic Signature) t Date
SECTION 7b:OWNER'OR AUTHORIZED AGENT DECLARATION
By entering my name below,I hereby attest under the pains and penalties of perjury that all of the information
con ' ed in this applicatio is tru and accurate to the best of my knowledge and understanding.
r7:�
41�—t Owner's or Authorized Agent's Name(Electronic Signature) Date
NOTES:
1. 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.mass.gov/oca Information on the Construction Supervisor License can be found at www.mass.gov/dpss
2. When substantial work is planned,provide the information below:
Total floor 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
3. "Total Project Square Footage"may be substituted for"Total Project Cost"