BPA 17-239 ABOVE GROUND POOL The Commonwealth of Massachusetts
Board of Building Regulations and Standards SALEM
Massachusetts State Building Code,780 CMR 11nn''1 ev r
ilte
Building Permit Application To Construct,Repair,Renovate Or DemolN a A � d
N One-or Two-Family Dwelling
' This Section For Official Use Only
Building Permit Number: Date Applied:
Building Oficial(Print Name) Signature Date
SECTION 1:SITE INFORMATION
l opgrty�d ress �� 1.2 Assessors Map&Parcel Numbers
1.1 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.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 Ow er'of Record: ,
�� t 1t 1 }al p SCa\c vy-) MA ( )\q +0
Name(Print) City,State,ZIP
23 Hpc Vm �A ���=1 do-531n �n (lei
No.and Street Telephone Email Address
SECTION 3:DESCRIPTION OF PROPOSED WOR10(check all that apply)
New Construction❑ Existing Building❑ Owner-Occupied ❑ 1 Repairs(s) ❑ Alteration(s) ❑ 1 Addition ❑
Demolition ❑ I Accessory Bldg.❑ Number of Units I Other ❑ Specify:
r of D cription of Proposed Work2:
SECTION 4:ESTIMATED CONSTRUCTION COSTS
Item Estimated Costs: Official Use Only
Labor and Materials
1.Building $ 1. Building Permit Fee:$ Indicate how fee is determined:
❑Standard City/Town Application Fee $
2.Electrical $ ❑Total Project Costa(Item 6)x multiplier c30x
3.Plumbing $ 2. Other Fees: $
4.Mechanical (HVAC) $ List:
5.Mechanical (Fire $ Total All Fees:$
Suppression)
q Check No. Cheek Amount: Cash Amount:
6.Total Project Cost: $ J� ❑Paid in Full ❑Outstanding Balance Due:_
Lt fo fyN 4 I%--� —A-V3 �A 0 M
f
SECTION 5: CONSTRUCTION SERVICES
5.1 Construction Supervisor License(CSL)
License Number Expiration Date
Name of CSL Holder
List CSL Type(see below)
Type Description
No.and Street
U Unrestricted(Buildings no to 35,000 cu. It.
R Restricted 1&2 Family Dwelling
City/town,State,ZIP M Masonry
RC Roo ling Covering
WS Window and Sidinit
SF Solid Fuel Burning Appliances
I insulation
Telephone Email address D Demolition
5.2 Registered Home Improvement Contractor(HIC)
HIC Registration Number Expiration Date
tlIC Company Name or HIC Registrant Name
No.and Street Email address
Ci Mown State ZIP Telephone
SECTION 6:WORKERS'.COMPENSATION INSURANCE AFFIDAVIT(M.G.L.c.152.¢2S.C(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 Isivance of the building permit.
Signed Affidavit Attached? Yes..........0 No...........G
SECTION 79:OWNER AUTHORIZATION TO BE COMPLETED.WHEN:`
OWNER'S AGENT OR CONTRACTOR APPLIES:FOR BUILDING PERMIT
1,as Owner of the subject property,hereby authorize -
t9 actb a f,in all matters relative to work authorized by this building permit application.
"y _��
m O an (Electronic Signature) Date
SECTION 71b:OWNEW ORAUTHORIZED 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:
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 nu 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.m;us.eov!oca Information on the Construction Supervisor License can be found at�www.nias.,o�-'Ins
2. When substantial work is planned,provide the information below:
'fotal 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
'fype of cooling system Enclosed Open
.i. "Total Project Square Footage"may be substituted for"Toed Project Cost"
p�.aT�•
S.E.C. & A 1r 'G.19N
138 NEWTON RSSOCIAATES9 LLC
D. P
LAISTOW, NH 03865
PHONE:603-382-5065
MORTGAGOR: PETER&MICHELLE L'ITALIEN
ADDRESS OF PRINCIPLE BUILDING: 23 NORTON T. SALEM,Mq
DEEQ REF. eK 32563 PG.529
PLAN REF. BK.2529 PG. 275
DATEEO �INSPECTION*ECTION:OCT. 17,2014
SCAL20
68.00
7—
LOT 31
O
I
a DECK P
o Qb
2
STORY
eslit OF
t
' - HOR'T"ON LOAD
Certiflcation to:ALIGN CREDIT UNION
This Mortgage Plot Plan was re
Mortgage purposes only prepare specifically for
to be a property and not intended or represented The apPproximate location of the principle structure/s conform
P perry line or land survey,This plan is not to be used with the horizontal building
to establish any of the Property"es for any purpose.No c°nstructed and/or is exempt from vlolgation enforcemfent�when
responsibility is extended to the land owner or occupant
This is a tape survey based on the location of survey markers of others. action under Mass B.L.Title VII,Chap.40A,Sec 7.
This plan Is not to be used for building permits or any such use. The ed i structure
located on this Plan is not
witthihi n a special flood hazard area as scaled from
Prepared for;DALTON&F►NEGOLD,LLP FIRM Map k 25009C-0419 G
Date:7/16/2014
File No.2014-1081
ZO/Ze 39dd SEC Job No.24543
S31bI00SSG-03S
900L6908L6 WdLI:TT bTOZ/IZ/0T
FI receptacle not less than 10', or not WIL=B /I
less than 6' if single, lockJng, grounding G R C
type E receptacle is used, _ s_F;
. harline/Atlantic/A
October 11
_
7 _
Ut
--;' 10'
-- —s•.3 -_�?��r nT 'isF�ti :..� ,....�^`L"�.��ca.a . ,f.:." Es _ � __.c� - �,��'�,..
_—
GFGI below_ re E
Cord less
with at 18-24" From pool f
; AWG
E , Motor
. Metal ladder bonded
6-20'
GFGI
125 volt 15- or 20-ampere -receptacle on general purpose
branch circuit, mo;-e than ', and less than 20' from inside
wall of pool, gust be GFCI prot rted, -