25 CROWDIS STREET - BUILDING JACKET The Comnwnwoalth of tlassachusetts r
Board of Building Regulations and Standards CITY OF
t L Massachusetts State Building Code, 730 0vIR SALEM
Revised blar 20l l
Building Permit Application To Construct, Repair, Renovate Or Demolish a
One-or Two-Family Dwelling
This Section For Official Use OnI
Building Permit Number: A ied
Building Ol icial(Print Name) Pato
gn
SECTION I:SITE INFORMATION
I.1 Property Address: 1.2 Assessors Map&Parcel Numbers
Z� O&JPI's x7t sec ��
1.1a 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 R) Frontage(R)
1.5 Building Setbacks(ft)
Front Yard Side Yards Rear Yard
Required Provided Required Provided Required Provided '
1.6 Water Supply: (M.O.L c.40,§54) 1.7 Flood Zone Informations 1.3 Sewage Disposal System:
Public❑ Private❑ Zone: _ Outside Flood Zone? Municipal❑ On site disposal System
❑
Check it yes[] p P y
SECTION2t PROPERTV'OW0ERSFID?F1: ,
2. Own or'of Record:
A�l moort-rq&9-S S ua . !' 4 de970
Name( int) City,Stare,ZIP
ZS^ C'zatr/DrS sf, Q7f/ 7YS-a3YY6 ,rs4
No.and Street Telephone Email Address
SECTION 3: DESCRIPTION OF PROPOSED.WOR&6heck all that apply)
New Construction❑ Existing Building❑ Owner-Occupied ❑ Repairs(s) ❑ 1 Alteration(s) ❑ 1 Addition ❑
Demolition ❑ Accessory Bldg. ❑ Number of Units_ I Other Ed Specify; ' le
Brief Description of Proposed Work': r1Oo S ,e i P A/-E ,1_- p slo
1✓4 ✓ Mew- 5/1 GL f)� R,4 Oki o FPS <7 s inP44 C'.Sr d/ r7n
SECTION 4: ESTIiVLAIED CONSTRUCTION COSTS-
Iterrt Estimated Costst OfRc1n1 Use Onjideermnel.,
Labor and Alatuials
1. Building g B 5'0 0 %"0 1. Building Permit Fee:S indicaed:
r. FlectricA y (?Slvrd�rd.City/fownApplication Fee '
❑'CotalProjcctCost'(Item6)smultipiie1. Plumbing\Icchanic.:l (1IVAQ y List:_
rotal All Ices:i
No. Cltcc!e Aluouut:r t] I'.till iu Pull CI outiCmJim, Itni
srcrum 5: c(1NS rltUC ION SERVICES
5,1 Construction Supervisor License(CSI.) C 5 Fd 19& S — l tl2 /�
License Number E. irati Data
dame ut'CSL 110 tar List t.'SL typo(sea below)
Type Description
No. and S eat Unrestricted Duildln s u to SSAUU w. tt.
'2f Cl_. �/ � �� d 12 Restricted IiiFnusil Dcvellin
\iasonr
C outin
ity,rown,Stat LIP Rl Rill
RC Cuverin
iVS window and Sidio
SF Solid Fuel Burning Appiiancus
I btsulatiun
Pala hung /'
Email address D Demolition
3.2 Registered no Improvement Contractor(HIC) iiilfL '7�lr� / ZU6
/ O FCV� p 11IC Registration Number spin ton Date
I IIC Company Name or IIIC Registrant Name
2 Email address
No.and Street
i /Town S to ZIP Tale hone
SECTION 6: WORKERS'COMPENSATION INSURANCE AFFIDAVIT(NI.G.L, e. 152. A 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 Issuan f the building permit.
Signed Affidavit Attached? Yes.......... No.......... Q
SECTION 7n:OWNER AU MORIZATIONTO BE 'L iL TED 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.
Data
Print Ownei s Name(Electronic Signature)
SECTION 7h: 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
contained in this application is truo and accurate to the best of my knowledge and understanding.
l+riot Uwnar';ur I thurited:\gent't N•une(Glee ruuie Sigunuue)
NOTES:
1. All Owner who obtains a building permit to do hivhcr u,vn work,or:m owner who hires an unregistered cuntnetor
(nut registered in the llome Improvement Cuntractur(HIC) Program),will no haves access to the arbitration
program or guaranty limd under bL(l.L. Q. l ►L\. Other important information on the HIC Program can be found at
aww nru<.,:uv%oca Intonnation on the Construction Supervisor I.icense can be Found at„ww.nrts.�, Ll
When sub.;rutiul work is planned,pruvi.le the infurmicladibalow:g finished basemendattic,,decks or purch)
_( Barn a
I'utnl flour area(i,1. It.) ._----- i Lnbitable tutu count _
t iroii tiviuq .11i("sy. 11.) -- Number of be,lrualns
NwiJl,vrotlJ., tImIlu
dumber tit b.uhrooln; _-_- ._-- - - -- -----
. -. - �,\IIIIIIJif III IaC6i% I'I+ri 11Ci __-_ -__
I:.ile ,lfh..uim, ;ja�ln _— - 1Jp�•II
--- Fucloi�d _--
I ', —
jI�r ll l'nq.•:t � lll ll•' I' ' t l•;i' IILIy bt ;I1b.11(IIIbI L'I"I •LII I'n'I•'�l t '•t•
ACCEPTANCE OF PROPOSAL
THE ABOVE PRICES,SPECIFICATIONS AND CONDITIONS
ARE SATISFACTORY AND ARE HEREBY ACCEPTED.
YOU ARE AUTHORIZED TO DO THE WORK AS SPECIFIED.
PAYMENTS WILL BE MADE ASOUTLINED ABOVE..
DATE OF ACCEPTANCE
SIGNATURE
SIGNATURE
SIGNATUR
PLEASE MAKE ALL CHECKS PAYABLE TO
CHRISTOPHER R. COYNE SR. THANK YOU!!
ew'v voo . <ia �oGC�42� Dock v �nvr 9��®si7
e�e
15 (MOWDIS STREET
cod
GOD
a
.cawl TIFICATE ISSUED- -
DATE 2/ .4/92
�. CITY-OF SALEM
SALEM, MAcS( SACh.O<UrSET011 —'
�= B
UI.LDING:�
PERM
ITS. . 1970T�nEEaCCRTFI ,lOCCTUP-
A`E
NiIY
SBMay 11 PE I7N 348
C; °"Te T eaoy i IL
Hoton Mouzith ae
•�,�.D C+ .;r IcaN,R•s�ucc
Nf�l-
s ; t 1
cct i Fam. rdwell�in 2 i NUMBER OF I
a'PERMIT TO�-' i 1 5 ORY ° DWELLING.UNITS
Ere
+ F[ OY 1I4.POY[MCMiI I MO II PROYOSLO Yf CJ
I
ZONING
�41Lot4r t1_25.Crow$�.e St• .( 't ( Wbd 41 ' !' ( � { ( �, D1stR ICT7W5 i R-I
AND U.
y'C�
- BETW'E`l. n I<RO[5 fiRf CTI) 4 .l"_ (CPO55 STREET)
W
! I 1 ( eoT jf I ( I
( I OT BLOCKSIZE
-
SUBDIVISiOA -
r.,.,Jr
BUDINGD
1 -,ro BE ' FT. E PT • 1 FT. LONG BY t FT.,IN 'HEIG HT AND SHALL-CONE ORM71N CONSTRUCT ION
IL
TO TYPE y' i USE GROUP I I SASEMENTWALLS.OR FOUNDATION 7 IPE)
;AEMARNS.r, .Erect 1 fan;il dwell in2
^ s_ ItRCH ON REAR OFiH0USE, I"SEEIENCZQSED PIAT PLAN $ IPA(iE A;09SI A2tli
SSIBLE CODE, VIOLATION'ON SET .49
AREA OR MINIMUM`
VOLUME
C ;SIP SOUARE,Ff ETI El ilIslas fa
$PiroB d Fotone Mouzithrae �^IYf'NV^lu^If.Y9I E.Y'.YIerNVY:'FIbrKIvaYIvfT R.f'N EYf'FIA.!'N ETY71Vt'FIY
OWNER TO BE POSTED ON PREMISES
eIIPnel AVC. , Peabody ILA SEE REVERSE S1DE FOR CONDITIONS OF CERTIFICATE
ADDRESS In a �or It°ylli:�__
dP T �QABP�IT��
q•1.