BPA 17-276 REDO KIT & BATH (002)ye:
the Commonwealth of Massachusetts
CITY OF
Board of Building Regulations and Standards
SALEM
Massachusetts State Building Code, 780 CMR Revised,blur 2011r
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.Ap lied:
V
Building Official(Print Name) Signature Date a —
SECTION I:SITE INFORMATION`
1.1Pr operty Address: 1.2 Assessors NIap&Parcel Numbers
If ct tj r&n Pad
Map Number Parcel Number
I.la Is this an accepted street?yes no p
1.3 'Zoning Information: 1.4 Property Dimensions: W
Luning District Proposed Use Lot Arca(sq ft)Frontage(It)
1.5 Building Setbacks(ft)
Front Yard Side Yards Rear Yard
Required Provided Required Provided Required Provided
1.6 Nater Supply:(M.G.L c.40,§54) 1.7 Flood Zone Information: 1.8 Sewage Disposal System:
Zone: _ Outside Flood Zone? Municipal On site disposal system
Public Private Check if yesO
SECTIO1142: PROPERTY OWNERSHIP"
2.l Owne of.Record:
r Sa l
m
n n Yi p1
G tr O
Name(Print) city,State,ZIP
L .[
1k)
J /'
No.and Street Tt ` r Oqe
Telephone Email Add s
SECTION 3: DESCRIPTION OF PROPOSED WORK'(check all that apply)
New Construction Existing Building Owner-Occupied 1 Repairs(s) 13Alteration(s) 13 Addition E3
Demolition Accessory Bldg. Number of Units I Other Specify:
Brief Description of Proposed Work': t
em 6 ve wo
SECTION 4: ESTIMATED CONSTRUCTION COSTS
Estimated Costs: Official Use OnlyItem
Estimated
and Materials)
I. Building SSD0 1. Building Permit Fee:S Indicate how fee is determined:
Standard Cityrrown Application Fee
2. Electrical Total Project Cost(Item 6)x multiplier x
3. Plumbing S 2. Other Fees: S
4.Mechanical (I-IVAC) S
List:
5.,Mechanical (Fire Total All Fees:S
Suppression)
Check No.Check Amount: Cash Amount:
6.Tutu) Project Cost: f DD Paid in Full D Outstandin;Balance Due:
C
SECTION 5: CONST RUCTION SERVICES
5.1 Construction Supervisor License(CSL)
License Number Expiration Date
Name of CSL Holder List CSL'type(see below)
Type Description
No.iind Street
U Unrestricted(Buildings tip to 35,000 cu. Ii.
R Restricted 1&2 Family Dwelling
City/town,State,ZIP M Masonry
RC Roofing Covering
WS Window and Siding
SF Solid Fuel Burning Appliances
1 Insulation
Telephone Email address D Demolition
5.2 Registered Home Improvement Contractor(HIC)
FITC Registration Number Expiration Date
I 11 Company 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 IsAuance of the building permit.
Signed Affidavit Attached? Yes .......... No...........0
SECTION 7a: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 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,1 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 ledge and understanding.
FP-r , Tier's or Authorized Agent's Name(Eli:•tropic Signat e) 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(FITC)Program),will not have access to the arbitration
program or guaranty fund under M.G.L.c. I42A.Other important information on the HIC Program can be found at
xvww.mass.yov:'oca Information on the Construction Supervisor License can be found at www.mass.,ov'dns
2. When substantial work is planned,provide the information below:
Total floor area(sq. R.) 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. "l'utal Project Square Footage"may be substituted for'°rotal Project Cost"
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1 9r, Studio 26 Associates,LLC
Wannalancit Mills
First Floor-Suite100
175 Cabot Street
Lowell MA 01854
Ph 60"7541"
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Turcios Residence
LIVING ROOM
Rojo*8 Atltlr.ss
House Renovations
7 Laurent Rd
Salem MA
NO. REVISION DATE
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LOUNGE P'°'°d&.1
Preliminary Design
MUD COATS
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ROOM CLOSET Plans and 3D Views
eDeu 1/29/17
1
New Floor Plan
PRO ECT e:
3/16"=1'-0" 17-006
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