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B-17-33 PORCH TO NEW KIT. & MUDRM The Commonwealth of Massachusetts Board of Building Regulations and Standards CITY Massachusetts State Building Code, 780 CMR SALEM 1 Revised Mar 2011 (� Building Permit Application To Construct, Repair,Renovate Or Demolish a \\ One-or Two-Family Dwelling This Section For Official Use Only Building Permit Number: D e Applied: f'7 Building Official(Print Name) Signature IYate SECTION 1:SITE INFORMATION 1.1 Property Address: 1.2 Assessors Map&Parcel Numbers l.l a Is this an accepted street?yes no Map Number Parcel Number 1.3 Zoning Information: 1.4 Property Dimensions: EA (3 i6 361 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 S ply:(M.G.L c.40,§54) 1.7 Flood Zone Information: 1.8 Sewage Disposal System: Zone: _ Outside Flood Zone? Public Private❑ Check if yes❑ Municipal E On site disposal system ❑ SECTION 2: PROPERTY OWNERSHIP' 2.1 Owner'of Record: q I ;_,a 1 S'd- . �i e c� ae c•` U. Del ., C l�726 Name(Print) City,State,ZIP 0.UyJ IR 1 UPS rALcS�o �i�te2,l�P� 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) 07 Addition Demolition ❑ Accessory Bldg. ❑ Number of Units Other ❑ Specify: Brief Description of Proposed Work': b�L� ( .xs <J 1�1t a �, 11_J61 re�c�� i On, a�l SECTION 4:ESTIMATED CONSTRUCTION COSTS f Item Estimated Costs: Official Use Only Labor and Materials 1.Building $ 'TOU 1. Building Permit Fee:$ Indicate how fee is determined: 2.Electrical $ 6 �U El Standard City/Town Application Fee ❑Total Project Cost (Item 6)x multiplier x 3.Plumbing $ 8' 6UU 2. Other Fees: $ 4.Mechanical (HVAC) $ List: 5.Mechanical (Fire $ Suppression) Total All Fees:$ p- Check No. Check Amount: Cash Amount: 6.Total Project Cost: $r%�J QQ 0 ❑Paid in Full 0 Outstanding Balance Due: SECTION 5: CONSTRUCTION SERVICES 5.1 Construction Supervisor License(CSL) Jt`T 4) K4AV V(A-f License Number Expiration bate Name of CSL Holder ` 1 ct List CSL Type(see below) 1 © �-�'C y�q�il�f.4s.i�" � Ty Description No.and Street p Unrestricted(Buildings up to 35,000 cu.ft.) Restricted 1&2 Family Dwelling City/Town,State,ZIP M Mason ry RC Roofing Covering WS Window and Siding _ SF Solid Fuel Burning Appliances I Insulation Telephone Email address WL D Demolition 5.2 Registered Home Improvement Contractor(HIC) �V V—KJ HIC Registration Number Expiration Date HIC Comrpny Name or HIC Registrant Name No.and Street Email address 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 .......... 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 A i&« uo" to act on my behalf, in all matters relative to work authorized by this building permit application. Print Owner's Name(Electronic Signature) Dat SECTION 71b: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 true and accurate to the best of my knowledge and understanding. 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.eov%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"maybe substituted for"Total Project Cost" pul, DEMOLISH EXISTING CHIMNEY NEW CEDAR CLAPBOARD TO MATCH EXISTING F-- 7- -------- -- f 7777J ACCESS TO CRAWPANELL SPACE - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - REAR. ELEVATION SCALE: 1/4 V-O"