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11 FOREST AVENUE BPA-17-273 $q Cly- ZSpsS The Commonwealth of Massachusetts �-AL Board of Building Regulations and Standards Massachusetts State Building Code,780 CMR SALEM ALEMl q� 51 Building Permit Application To Construct,Repair,Renovate Or Demolish a t One-or Two-Family Dwelling This Section For Official Use Only Building Permit Number: Date Appl' d: I Building Official(Print Name) Signature Date SECTION 1:SITE INFORMATION 1.1 Property Address: 1.2 Assessors Map&Parcel Numbers I 1�©\zf-57 AUf / 1.1a 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 OWNERSIIIPI 2.1 Owner'of Record: �Y ( c�f3 1 5 A L�4_1 ruin 16 I�l 7 Name(Print) City,State,ZIP k J t C)12 7 q-)Z6 317 !I A'2 c) No.and Street Telephone Email Address SECTION 3:DESCRIPTION OF PROPOSED WORIO(check all that apply) New Construction❑ Existing Building❑ Owner-Occupied ❑ 1 Repairs(s) Alteration(s) ❑ 1 Addition ❑ Demolition ❑ Accessory Bldg. ❑ Number of Units I Other ❑ Specify: Brief Description of ProposedWork2: T24 Ai L— 13E\L'k- VoRcP rr✓l +'h Ai VV O/.-% — v PA , tr _ 7 13 5 pin oo 7 IX ii< SECTION 4:ESTIMATED CONSTRUCTION COSTS Item Estimated Costs: Official Use Only Labor and Materials 1.Building $ 1. Building Permit Fee:$L_Indicate how fee is determined: 2.Electrical $ p�—� ❑Standard City/Town Application Fee ❑Total Project Costi3(Item 6)x multiplier x 3.Plumbing $ 2. Other Fees: $ 4.Mechanical (HVAC) $ List: 5.Mechanical (Fire $ Total All Fees:$ Suppression Check No. Check Amount: Cash Amount: 6.Total Project Cost: $ v ❑Paid in Full ❑Outstanding Balance Due: SECTION 5: CONSTRUCTION SERVICES 5.1 Construction Supervisor License(CSL) �.S Q t 3(1 '1 C S 0 7o % 3 b License Number Erprratrun ate NameeoffCSL Holder / List CSL Type(see below) / " (�o`v Type Description No.and Street kJ _` ` �� 5 U Unrestricted(Buildingsa to 35,000 cu. 11. T`�/l V- R Restricted I&2 Family Dwelling Cityfrown,State,ZIP ivt Masonry i61' 6 2 RC Roolinst Covering WS Window and Siding SF Solid Fuel Burning Appliances sq, ct 3 1 Insulation Telephone Email address D I Demolition 5.2 Registered Home Improvement Contractor(HIC) lyz(el 01C2 u kAe- HIC Registration Number Exiru on Date HIC 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.¢2$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 Wuancofthe building permit. Signed Affidavit Attached? Yes.......... No...........13 SECTION las.OWNER AUTHORIZATION TO BE.COMPLETED.W HENt 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 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 app)ica on is true and accurate to the best of my knowledge and understanding. ICP (olr 91113 �7 Print wier's or Authorized Agent's Name(Electronic Signature) ate 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►tut 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 %v,vw.mass.gov'oca Information on the Construction Supervisor License can be found at www.mass.1goy4lns . 2. When substantial work is planned,provide the information below: Total floor area(sq. If.) 'I (including garage,finished basement/attics,decks or porch) Gross living area(sq. ff.) 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. "Fotal Project Square Footage"may be substituted for"Total Project Cost" -1 16'-0" 1� ° IL BA if j 9-11 Forest Ave. Back porch deck rebuild T-4 1/4" T-41/4" . 2"x8"s 12"on center A a Z'-..0:-.1 _ ___-___-_ If_ 10 I 6"Colonial 41 Posts cn is Bulkhead Bulkhead ;, -- – -- —_ r r, a Ili I I 4 I 810"x4'construction - tubes 9-11 Forest Ave. Back porch deck rebuild SITE CONDOMINIUM PLAN �- c�-� SALEM, MASS. (, SCA L- I = 10' FE@.,?7,DGI rJ CARTER R T,)WFRS FN.G;NEEfiI?IC S'NAMPSr,7TT,MASS. WILLIAM S SYLVIA MNYNI.HAX �I I ,� rr a' ' 1 U j I N C W � F y 6ApAGE JNIYEM At � GJa�q JN �� AAE Q iG?U9r•'0 STONE) 4 r w "- ��w dem\� q I� ,,y/,' - V_ Wi.lJC I, I. DWE LING i .,GAJ J r o 4 UN!T 9 UNI I 11 A' c i NC !1 �ti1 I I �1 FOR arci Tar OF G Jr-ai t.J_ I FOREST' �V . F' T f � _ FLAN d�ffK i r �`L�N�, 13Ye%e Gtl.M Ot pi[C9 ap yyT rhe rp(nu'I't'k J."eto�: 43'tr<t � I ✓ !- SLATE t"= 5J