20 FEDERAL STREET #8 BPA 17-118 14 The Commonwealth of Massachusetts = j N�p{�+aa+
ItIFF1 tAL
k'## j Board of Building Regulations and Standards CliT OF
101 Massachusetts State Building Code, 780 CMR 10 j 1 �� SALEM 23
Building Permit Application To Construct, Repair,Renovate Or Demolish a
One-or Two-Family Dwelling
1 This Section For Official Use Only
Building Permit Number: Date Ap teAd:
1
Building Official(Print Name) Signature Date
SECTION 1:SITE INFORMATION
1.1 Property Address:
FR� Uh(�, 1.2 Assessors Map&Parcel Numbers
,0 4rA� Sk
�
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'
7- wner'of Record:
�y13-�d"T Y� 1✓�� �\ `�Z 5
Name(Print) City,State,ZIP
No.and Street Telephone Email Address
SECTION 3:DESCRIPTION OF PROPOSED WORKZ(check all that apply)
New Construction❑ Existing Building❑ Owner-Occupied ❑ Repairs(s) ❑ Alteration(s) ❑ Addition ❑
Demolition ❑ Accessory Bldg. ❑ Number of Units Other 4 Specify: ,e �S
Brief Description of Proposed Work 2: m aW S 4r cL
O � n pcY
SECTION 4:ESTIMATED CONSTRUCTION COSTS
Item Estimated Costs: Official Use Only
(Labor and Materials)
1. Building $ $ t4,19 00 1. Building Permit Fee:$ Indicate how fee is determined:
❑Standard City/Town Application Fee
2.Electrical $ ❑Total Project Costa(Item 6)x multiplier x
3.Plumbing $ 2. Other Fees: $
4.Mechanical (HVAC) $ List:
5.Mechanical (Fire $
Suppression) Total All Fees:$
Check No. Check Amount: Cash Amount:
6.Total Project Cost: $ $ 00' ❑Paid in Full ❑Outstanding Balance Due:
J (DtA —1� ( - 3Q,1 - I �kti
2-1 Z V M1:!�,t L-I✓-D G .0 .