BP APP 17-28 The Commonwealth of Massachusetts 'JL1% '
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Board of Building Regulations and Standards dTY OF
~ SALEM
Massachusetts State Building Code, 780 CMR
wk "11 ;x I•l , ` A Qvijed Mar 2011
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N Building Permit Application To Construct, Repair, Renovate Or Demolish a
One-or Two-Family Dwelling
This Section For Official Use Only
1 Building Permit Number: Date Applied:
Building Official(Print Name) Signature f' Date
SECTION 1:SITE INFORMATION
1.1 Property Address: 1.2 Assessors Map& Parcel Numbers
20 Victory Road
1.1 a Is this an accepted street?yes no Map Number Parcel Number
1.3 Zoning Information: 1.4 Property Dimensions:
RESIDENTIAL
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.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 yes[]
SECTION 2: PROPERTY OWNERSHIP'
2.1 Owner'of Record:
Hans Springensguth SALEM, MA. 01970
Name(Print) City,State,ZIP
20 Victory Road (978) 530-8688 hans.springensguth@comcast.net
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) ❑ 1 Addition ❑
Demolition ❑ Accessory Bldg. ❑ Number of Units Other ❑ Specify:SOLAR PV
Brief Description of Proposed Work':Install Solar Electric panels on roof of existing home,to be interconnected with the
home's Electrical System(30 panels at 9.45 kW)
SECTION 4: ESTIMATED CONSTRUCTION COSTS
Item Estimated Costs: Official Use Only
Labor and Materials)
1. Building $4,000 1. Building Permit Fee: $ Indicate how fee is determined:
2. Electrical $10,000 ❑Standard City/Town Application Fee
❑Total Project Cost- (Item 6)x multiplier x
3. Plumbing $ 2. Other Fees: $
4. Mechanical (HVAC) $ List:
5. Mechanical (Fire $
Su ression) Total All Fees:$
Check No. Check Amount: Cash Amount:
6.Total.Project Cost: $ 14,000 ❑Paid in Full ❑Outstanding Balance Due:
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SECTION 5: CONSTRUCTION SERVICES
5.1 Construction Supervisor License(CSL)
101687 9/13/2018
SOLARCITY CORP./DANIEL D. FONZI License Number Expiration Date
Name of CSL Holder
List CSL Type(see below) u
800 RESEARCH DR
No.and Street Type Description
U Unrestricted(Buildings u to 35.000 cu.ft.)
WILMINGTON MA.01887 R Restricted 1&2 Family Dwelling
City/Town,State,ZIP M Masonry
j RC Roofing Covering
: . WS Window and Siding
SF Solid Fuel Burning Appliances
978-215-2383 DFONZI@SOLARCITY.COM 1 Insulation
Telephone Email address D Demolition
5.2 Registered Home Improvement Contractor(HIC)
168572 3/8/17
SOLARCITY CORP. HIC Registration Number Expiration Date
HIC Company Name or HIC Registrant Name
800 Research Dr allison.kelley@solarcity.com
No.and Street Email address
Wilmington Ma. 01887 978-215-2383
Cit /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 ..........❑✓ No...........❑
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 solarCay/Daniel D Fonzl
to act on my behalf, in all matters relative to work authorized by this building permit application.
*See Contract/Owner Authorization 1/10/17
Print Owner's Name(Electronic Signature) Date
SECTION 7b: OWNER'OR AUTHORIZED AGENT DECLARATION
By entering my na clow hrt under the pains and penalties of perjury that all of the information
contained in t ' ppli on isurate to the best of my knowledge and understanding.
1/10/17
Print 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. og v/oca Information on the Construction Supervisor License can be found at www.mass.gov/dps
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"