0084 PROCTOR STREET BPA 17-138 .!t R-7
The Commonwealth of Massachusetts
Board of Building Regulations and Standards CITY OF
Massachusetts State Building Code, 780 CMR SALEM
Revised Mar 2011
00 Building Permit Application To Construct,Repair,Renovate Or Demolish a
One-or Two-Family Dwelling
This Section For Official Use Only
1
Building Permit Number: t D Applied: —'
5 / /
Y
Building Official(Print Name) Signature tBAt 37 -
1
SECTION 1:SITE INFORMATION 'S
1.1 Propert�ddress• 1.2 Assessors Map&Parcel Numbers
8 y 1"R-o c.T a A. s-r
1.1 a Is this an accepted street?yes ✓ no Map Number Parcel Number PJ
13 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�j Private❑ Zone: _ Outside Flood Zone? Municipal�On site disposal system 13�" Check if ye
so—SECTION 2: PROPERTY OWNERSHIP'
2.1 Owner' A Reco d• c�
dew,, �/� 0 i JP 2 d
Name(Print City,State,ZIP
'?y �twc�o� rT 603.` 99 3VJ2-
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) ilk Addition ❑
Demolition ❑ Accessory Bldg.13 Number of Units Other ❑ Specify:
Brief Description of Proposed Work2: 6 U 7 IK 4-rAo o -f- u I
SECTION 4:ESTIMATED CONSTRUCTION COSTS
Item Estimated Costs: Official Use Only
Labor and Materials
1.Building $ g 9 -► 1. Building Permit Fee:$ Indicate how fee is determined:
2.Electrical $ $ t� p ❑Standard City/Town Application Fee
❑Total Project Cost (Item 6)x multiplier x
3.Plumbing $ Z, d 0 2. Other Fees: $
4.Mechanical (HVAC) $ List:
5.Mechanical (Fire $ Total All Fees:$
Suppression)
Check No. Check Amount: Cash Amount:
6.Total Project Cost: $ 12, 562— ❑Paid in Full 0 Outstanding Balance Due:
SECTION 5: CONSTRUCTION SERVICES
5.1�pConstr/uction SupervisorLicense(CSL)
CAA I.�,f Cs tum Number�3
t �}�/ � , p� U� C,rr License Number Expiration Date
Name of CSL Holder I ) (J
n,n ��i � Il/'f- List CSL Type(see below)
No,and S treet(�` ` + Type Description
-3 U Unrestricted(Buildingsu to 35,000 cu.ft.
R Restricted 1&2 Family Dwellin
City/Town,State,ZIP M Masonry
RC Roofing Covering
WS Window and Siding
d.h SF Solid Fuel Burning Appliances
M14: IIjwdl I Insulation
Telephone Email address D Demolition
5.2 Registered Home Improvement Contractor(HIC) z00 Z.� .
IMP G Ujy r / /,y 16 M HIC Registration Number Expiration Date
HIC Company Name or HIC Registrant Name
�16f3P—V-r Ake— PP,9-&AJf,Q-V01ON•C.1.4
No.and Street Email address
TM1UV ; AM- Di 9 y 3
City/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 Issuance of the building permit.
Signed Affidavit Attached? Yes .......... No...........❑
SECTION 7a:OWNER AUTHORIZATION TO BE COMPLETED WHEN
OWNER'S AGENT OR CONTRACTOR APPLIES FOR BUILDING PERMIT
7
I,as Owner of the subject property,hereby authorize 'V`6 e-/ 1)111L DN, I'�"�
to act on my behalf,in all Fitter7slative o work authorized by this building permit application.
_ � ,., 3. z.✓� �
Print Owner's Name(Electronic Signature) Date
SECTION 7b:OWNER'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 pplication is true and accurate to the best of my knowledge and understanding.
Priv Owner's or Authorized Agent's a(Electronic Signature) Date
NOTES:
1. 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 not 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.mass. og v/oca Information on the Construction Supervisor License can be found at www.mass. ovg /dns
2. When substantial work is planned,provide the information below:
Total 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
Type of cooling system Enclosed Open
3. "Total Project Square Footage"may be substituted for"Total Project Cost"
7'-2"
X-101/2" X-3 1/2"
Full gut
Ceilings 9-0-AFF
rile shower walls to T-O"AFF
Add wall cabs(2)
Tile floor
Custom PVCmouldings
Add ventilation
ELEC: 1 recessed, 1 track light 3 switch
Radiator(built in wall) 7-10'x 4r
o ;= Curved shower rod
C' a - z
e
3 N
to LO
Delete and reframe wall Fir out to accept
to accept prefab closet. 30"tub
t
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Cn
n
MDB Construction Mr. & Mrs. Soulard
4 Tibbetts Ave 84 Proctor St.
Danvers, Ma 01923 Salem, Ma 01970
-,1" 2-0" Not to scale
1'-3" 3-11" 2-4"
7-2"