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0048 BARSTOW STREET BPA-17-143 BUILD CLOSED IN REAR PORCH `4y j5 .� "Che Commonwealth of Massachusetts CITY OF a Board of Building Regulations and Standards SA�c hl� �J Massachusetts State Building Code, 780 CMR X 11 �evt�ed Xhir 2011 Building Permit Application To Construct, Repair, Renovate Or Demolish a One-or Two-Family Dwelling ® This Section For Official Use Only t Building Permit Number: Date. pPlied: I Building Official(Print Name). Signature Date SECTION 1:SITE INFORMATION' 1.1 Property Address: 1.2 Assessors�I'Iap&Parcel Numbers e!A11 � (711 Z 6 i d e g 1.1 a Is this an accepted street9 yes no Map Number Parcel Number 1.3 'Lotting Information: 1.4 Pro r6. rtty Dimensions: s "Luning District Proposed Use Lot A -a(sq ft) Frontage(It) 1.5 Building Setbacks(ft) Front Yard Side Yams Rear Yard Required Provided Required Provided Required Provided ©i 1.6 Water Su ly:(h1.G.L c.40,§54) 1.7 Flood Zone Information: 1.8 Sewage Disposal System: Zone: _ Outside Flood Zone Municipal site disposal system C3Public Private❑ Check if es SECTION 2: PROPERTY OWNERSHIP' 2.1 Owner'of Record- t me(Print) City,State,ZIP Y4 ZAC.074.,) s'r-: 778-goy- /cY No.and Street Telephone Email Address SECTION 3: DESCRIPTION OF PROPOSED WORW(check all that apply) New Construction❑ Existing Building❑ Owner-Occupied ❑ 1 Repairs(s) ❑ 1 Alterntion(s) ❑ Addition Demolition ❑ Accessory Bldg.❑ 1 Number of Units Other ❑ Specify: Brief Description of Proposed Work': Aafi h d C w ft!�A 7 If r Z Z SGi u NJ w cd L SECTION 4: ESTIMATED CONSTRUCTION COSTS Estimated Costs: Official Use Only Item Labor and Materials) I. Building ��d I. Building Permit Fee:S Indicate how fee is detennined: ❑Standard City/Town Application Fee 2. Electrical S ❑Total Project Cose(Item 6)x multiplier x 3. Plumbing S 2. Other Fees: S 1.`Icchanical (FIVAC) S List: 5.\lechanical (Fire Total All Fees:S Suppression) Check No. Check Amount: Cash Amount: 6.Total Project Cost: 'S Y e 0 ✓ ❑Paid in Full O Outstanding Balance Due: 3 I� ►ta �� �� y P�� i SECTION 5: CONSTRUCTION SERVICES ` 5.1 Construction Supervisor License(CSL) C,�— 0 A Tl, �(1 ——/1?---/ 5` �ffZL/�� License Number Expiration Date Name of CSL Holder List CSL'rype(see below) LL Type Description No and Street U Unrestricted(Buildings tip to 35,000 cu. It. XMe / r 6 R Restricted 1&2 Fainily Dwelling City/fo%n,State,ZIP ►M Masonry RC Rooting Covering WS Window and Sidin SF Solid Fuel Burning Appliances Insulation Tele hone Email address D Demolition 5.2 Registered Home Improvement Contractor(HIC) 7 1557,r J-6 B it Pirf-1,?5:–gl — HIC Registration Number Expiration Date 111C Company Name or HIC Registrant Name 1f 0 No.an Street ?7 0�, �� Email address &044c</0. d_ Ci /Town State ZIP Telephone SECTION 6:WORKERS'COMPENSATION INSURANCE AFFIDAVIT(M.G.L.c. 152.$2SC(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 Is§uance of the building permit. Signed Af'f'idavit Attached? Yes .......... No...........❑ 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,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. - - &. POe/S -7-12-g / /-7 . 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 not have access to the arbitration proram or guaranty fund under M.G.L.c. I42A.Other important information on the HIC Program can be found at www.mass.gov'oca Information on the Construction Supervisor License can be found at w��►i.n►:iss.�ov'dms 2. When substantial work is planned,provide the information below: 'focal 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 ror"Total Project Cost" c� PLAN or LAND w �—' VV I L FRED ,.f BEG I AJ SALEM MA.SS. Scale inch = >> f?c�- rat. 1949 -,;� V441x"ISTM GF PRE 91,S 0,DIST aRlKlll MASS. Ammi-i -30-A-6-.16 .i4yq Wig#► '1r ' . 041,f I � � FLYNN JOLT a FLYIMpq yy h-TKEY —C7 n3e3 f. uz CCI o N Nt G1 Has.0a TO s J.�r9SGN 57 -+• ti 2x8 VcQ i oc it Ir it ji VY --- i - 9 i; _- . . 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