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BPA-17-272 PORCH Lf'2 Lt 2S7<3 72, z The Commonwealth of Massachusetts Board of Building Regulations and Standards SALEM W Massachusetts State Building Code,780 CMR SALEM 2011 APR ( 3RejAed4¢lc64011 j Building Permit Application To Construct,Repair,Renovate Or Demolish a One-or Two-Family Dwelling This Section For Official Use Only Building Permit Number: Date Appl' d: 1 Building Official(Print Name) Signature Date SECTION 1:SITE INFORMATION 1.1 Property Address: 1.2 Assessors Map&Parcel Numbers -:PQR-0.7 4V 1.1 a Is this an accepted street?yes l 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 Owner'of Record: CI?Al Az A4 HA rLt� 5p"Ce-0 , tVA Q l q.)o Name(Punt) City,State,ZIP I 'Ft7Q E57 0/L v) 6673 00.�, No.and Street Telephone Email Address SECTION 3:DESCRIPTION OF PROPOSED WORKZ(checkA that apply) New Construction❑ Existing Building❑ Owner-Occupied ❑ 1 Repairs(s) Alteration(s) ❑ 1 Addition ❑ Demolition ❑ Accessory Bldg.❑ 1 Number of Units I Other ❑ Specify: Brief Description of Proposed Work2: v ALIS BON-f-0 1240C CX6W4a W CO PaS P Ol 49 ti A T &46:6/ 1-28-iL S ifaeru vr✓! 0 S 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 $ �O ❑Total Project Cost'(Item 6)x multiplier x 3.Plumbing $ 2. Other Fees: $ 4.Mechanical (HVAC) $ List: 5.Mechanical (Fire $ Total All Fees:$ Suppression) l Check No. Check Amount: Cash Amount: 6.Total Project Cost: �CGIOU . 13 Paid in Full 0 Outstanding Balance Due: J SECTION 5: CONSTRUCTION SERVICES 5.1 Construction Supervisor License(CSL) o re 3 6, i License Number Expiration ate Name of CSl!LH,older List CSL Type(see below) U Type' Description No.quid Street ` U - Unrestricted(Buildingsa u. Rto 35,000 c . ©�� Q R Restricted l&2 Family Dwelling Cityfrown,State,ZIP M Imasonry RC Roolinit Coverin WS Window and Sidin SF Solid Fuel Burning Appliances 1 Insulation Telephone Email address D I Demolition 5.2 Registered Home Improvement Contractor(HIC) /), (10/aZ y t L 4 HIC Registration Number Exprrut on Date tncCom any Nam 1 Regis I t Na S� No.a id Street Email address ` /j nti�1 . C,I �Fl su26 Ci /Town State ZIP Telephone SECTION 6:WORKERS'COMPENSATION INSURANCE AFFIDAVIT(M.G.L.C.In 4 25C(6))-" Workers Compensation Insurance affidavit must be completed and submitted with this application. Failure to provide G this affidavit will result in the denial of the Wcrane f the building permit. Signed Affidavit Attached? Yes ..........d No...........O SECTION 7a.OWNER AUTHORIZATION TO BE COMPLETED.WHEN:` OWNER'S AGENT OR CONTRACTORAPPLIES`FOR BUILDING PERMIT' I,as Owner of the subject property,hereby authorize - t9 act on my behalf,in all matters relative to work authorized by this building permit application. 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 understanding. 12 . CyA (/- (r ) 3 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 INI.G.L.c. I42A.Other important information on the HIC Program can be found at w,vw.rn:uS.eov!oca Information on the Construction Supervisor License can be found at Is 2. When substantial work is planned,provide the information below: "focal tloor area(sq. ft.) '� (including garage,finished basement/attics,decks or porch) Gross living area(sq. tt.) 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 .1. ""Dotal Project Square Footage"may be substituted for"Total Project Cost" -� 16'-0" O O a _ i 9-11 Forest Ave. Back porch deck rebuild T-4 1/4" 7'-4 1/4" 2NS"s 12"on center ' Y - ----= -= — n - 101 I� —— ———— -— —-—-—-— — -- — —— -- 11 4 T - -- -- -- - -- ———— �---- — ----- — _ I -- — — 6colonial == - - _— " II, Posts jai '- Bulkhead Bulkhead r IP lig a 8 10"x4'construction— �J ---- -� -- - -- -� -I tubes 9-11 Forest Ave. Back porch deck rebuild SITE CONDOMINIUM PLAN SALEM, MASS. SALE i 10' FEfa.:°%,1961 GARTER q TOWERS ENG.NEERINC SWAMPSMTT,MASS. IWILLIAM 9 SYLVIA MOYNIHA,N 1 i { 1 R I� L , F {, GAP AGE J -' �f IDRIVEWAt ( APE AJN Q iGP.US t:'_-n STONE; La ... 5 f o Ay �G Dfr .:LING � Aogn s z C, vy UNIT 9 tiNll If I PORCH T 7 � 1 1 FOR PF.I$TRY OF FOREST AVE, PLAN d:)OK i^�rL"N �Isf to RroY A47T aEic7]p piT. �� ""' ?"' "r•+.: "��. r h9V'rMpwdr ( r ..