3 ABORN ST SOLAR PANELS TBA-17-226 .9-
i\ The Commonwealth of Massachusetts CITY OF
/Y1 ) Board of Building Regulations and Standards
( J Massachusetts State Building Code,780 CMR SALEM
Revised Mar 2011
Building Permit Application To Construct, Repair,Renovate Or Demolish a
OOne-or Two-Family Dwelling
This Section For Official Use Only
Building Permit Number: Date Appli :
Building Official(Print Name) Signa re Da e
SECTION 1:SITE INFORMATION
1.1 Prope Y Ador 1.2 Assessors Map&Parcel Numbers
l.la Is this an accepted street?yes-x 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.40,§54) 1.7 Flood Zone Information: 1.8 Sewage Disposal System:
Zone: _ Outside Flood Zone?
Public C3 Private❑ Check if yes❑ Municipal EJOn site disposal system ❑
SECTION 2: PROPERTY OWNERSHIP'
2"'
Minerva Salem MA 01970
Name(Print) City,State,ZIP
3 Aborn st 9787895785 Legerm@comcast.net
No.and Street Telephone Finail Address
SECTION 3:DESCRIPTION OF PROPOSED WORK2(check all that apply)
New Constructioal:1- Existing Building❑ Owner-Occupied ❑ 1 Repairs(s) ❑ 1 Alteration(s) ❑ Addition ❑
Demolition ❑ I Accessory Bldg.❑ Number of Units Other ❑ Specify:
Brief es1ription of Proposed Work'`: r
SECTION 4:ESTIMATED CONSTRUCTION COSTS
Item Estimated Costs: Official Use Only
(Labor and Materials)
1.Building $2 ki/ f. 1. Building Permit Fee:$ _Indicate how fee is determined:
❑Standard City/Town Application Fee
2.Electrical $ ❑Total Project Cost'(Item 6)x multiplier x
3.Plumbing $ 2. Other Fees: $
4.Mechanical (HVAC) $ List:
5. Mechanical (Fire $ Total All Fees:$
Suppression)
j Check No. Check Amount: Cash Amount:
6.Total Project Cost: $ l 0 Paid in Full 0 Outstanding Balance Due:
L
SECTION 5: CONSTRUCTION SERVICES
5.1 Construction Supervisor License(CSL)
License Number Expiration
Na .— d44er
List CSL Type(see below)
No. trees (� Type Description
i11 Unrestricted(Buildings u to 35.000 cu.R.)
V lt1 R Restricted 1&2 Family Dwelling
City own,Statc,711' M Masonry
RC Roofing Covering
WS Window and Siding
( �A SF Solid Fuel Burning Appliances
Insulation
Telephone i J Email address D Demolition
5.2 Registered Home Improvement Contractor(HIC) Wbiq& l
Sa . IIIC Registration Number Expiration Date
IIIC Company Na r HIC istrant Nam
0f)k4sAr-�oy
No.and Street
�l - t' U1 J,,ao& 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 ........✓0-' No...........13
SECTION 7a:OWNER AUTHORIZATION TO BE COMPLETED WHEN
OWNER'S AGENT OR CONTRACTOR APPLIES FOR B/U�ILDING PERMIT
1,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.
Minerva Zoquier 3/16/17
Print Owner's Name(Electronic Signature) Date
SECTION 7b:OWNEW 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 understandin .
Print O er s or Authorized Agent' Name(Electronic Signature) Date
NOTES:
I. 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.massygov/das
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"