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13 PLANTERS STREET - BUILDING JACKET 13 PL RN't-�S S i irsuperTab. lar9arL"Man 1 MEA6 KEEPING YOU ORGANIZED No. 10301 PMWFE M IMM[ ImL wnrlm farlaw Od11B1�WR � m P'06T4mam �m V"Num GET ORGAN®AT SYEAD.COM Certificate Number: B-15-936 Permit Number: B-15-936 Commonwealth of Massachusetts City of Salem This is to Certify that the ..................................................................................._Building.................................................. located at ......................... Building Type ....................................................................._ll PLANTERS STREET...................................................................... in the .....................................City of Salem ............................................ . ................................................. Address Town/City Name IS HEREBY GRANTED A PERMANENT CERTIFICATE OF OCCUPANCY New single family home This Permit is granted in conformity with the Statutes and Ordinances relating thereto, and expires ...............................NotApplicable..........., unless sooner suspended or revoked. Expiration Date Issued On: Monday, February 08, 2016 Registry ID: 034 EH063 Rating Number: EH0634 A!/UW SALE PlantersSt 11 Certified Energy Rater: Inette Rex Rating Date: 2/42016 11 Planters St Rating Ordered For: Salem,MA01970 Estimated Annual Energy Cost www Confirmed 5 Stars Plus Use MMBtu cost Percent Confirmed Heating 41.0 $827 35% Cooling 3.5 $185 8% Uniform Energy Rating System Energy Efficient Hot Water 13.6 $259 11% 1 Star 1 Star Plus 2 Stars 2 Stars Plus 3 Stars 3 Stars Plus 4 Stars 4 Stars Plus 5 Stars 5 Stars Plus Lights/Appliances 21.3 $900 38% 500-401 j 400-301 300-251 250-201 200-151 150-101 1 1 100-91 90-86 85-71 70 or Less Photovoltaics -0.0 $-0 -0% HERS Index: 62 Service Charges $190 8% General Information - _ ZT - - _ Total 79.5 $2361 100% Condition ed Area: 1629 sq.ft. HouseType: Single-family detached Conditioned Volume: 13031 cubic ft. Foundation: Unconditioned basement - Bedrooms: 3 This home meets or exceeds the minimum - criteria for all of the following: Mechanical Systems Features Heating: Fuel-fired air distribution,Natural gas,92.1 AFUE. Cooling: Air conditioner,Electric, 13.0 SEER. J Water Heating: Instant water heater, Natural gas,0.95 EF,0.0 Gal. Dud Leakage to Outside: 81.00 CFM25. Ventilation System: Exhaust Only:46 dm,5.0 watts. Programmable Thermostat: Heating:Yes Cooling:Yes Building Shell Features, g- a. 7 - :. . Ceiling Flat: R-53.2 Slab: None Sealed Attic: NA Exposed Floor: R-30.0 Vaulted Ceiling: NA Window Type: U-Value:0.300,SHGC:0.450 Above Grade Walls: R-21.0 Infiltration Rate: Htg:709 CIg:709 CFM50 Foundation Walls: R-0.0 Method: Blower door test Lights and Appliance Features " .,� -�., s. n Inette Rex Percent Interior Lighting: 80.00 Range/Oven Fuel: Natural gas The Energy Hound Percent Exterior Lighting: 6.00 Clothes Dryer Fuel: Natural gas 11 Broadway,Suite 3 Refrigerator(kWh/yr): 717.00 Clothes Dryer EF: 2.67 Beverly,MA 01915 Dishwasher Energy Factor: 0.00 Ceiling Fan (cfm/Watt): 0.00 978-233-1433 The Home Energy Rating Standard Disclosure for this home is available from the rating provider. REM/Rate-Residential Energy Analysis and Rating Software v14.5.1 This information does not constitute any warranty of energy cost or savings. 01985-2014Archftectural Energy Corporation,Boulder,Colorado. Certified Energy Rater Commonwealth of Massachusetts a City of Salem 120 Washington St,3rd Floor Salem,MA 01970(978)745-9595x5641 Return card to Building Division for Certificate of Occupancy Permit No. B-15-936 FEE PAID: $910.00 PERMIT TO L;) %.FILD DATE ISSUED: 10/1/2015 This certifies that SKOMURSKI DEVELOPMENT LLC has permission to erect, alter, or demolish a building 11 PLANTERS STREET Map/Lot: 360238-0 as follows: New Construction - 1-2 Family:" iXtONSTRUCT ANEW SINGLE;FAMILY HOME Contractor Name: Joseph Skomurski DBA: Contractor License No: 79854 z - = 10/1/2015 'iBuing Official DateI r", It 41, This permit shall be deemed abandoned and invalid unless the work authorizedby this permit is commenced within six months after issuance.The Building Official may grant one or more extensions not to exceed six months each upon written request a , All work authorized b this permit shall conform to the a t ..n and Vii.=. y4 c men y p approved application and the approved construction documents for which this permit has been granted. r i , - :, All construction,alterations and changes of use of any#building and structures shall be in compliance with the local Toning by-laws and codes. This permit shall he displayed in a location clearly visible from accessdstreet or road and shall be maintained open forpublic inspection for the entire duration of the work until the completion of the same. =z The Certificate of Occupancy will not be issued until all applicable signatures by the Building and Fire Officials are?provided onthis permit. r _ -�:. tee_. d` 1,1� M . H IC#: "Persons contracting with unregistered contractors do not have access to the guaranty fund"(as set forth in MGL c.142A). y Restrictions: r « _ .• ` Building plans are to be available on site. All Permit Cards are the property of the PROPERTY OWNER. "�o Commonwealth of Massachusetts $, _ City of Salem .'�ar.�ne a 120 Washington St,3rd Floor Salem,MA 01970(978)745-9595 x5641 Return card to Building Division for Certificate of Occupancy Structure CITY OF SALEM BUILDING PERMIT Excavation PERMIT TO BE POSTED IN THE WINDOW ' If Footing INSPECTION RECORD Foundation Framing 0I/ Illi / Mechanical Insulation INSPECTION: By DATE Chimney/Smoke Chamber Final Plumbing/ as !�!/ Rough:Plumbing Fy� 0 �,,� 11 Rough:Gas. 'I rf 7 Final UElectrical _... Service 'oughf� =final Fire Department 'reliminary =final — 3 G Health Department 'reliminary °final Certificate Number: B-15-917 Permit Number: B-15-917 Commonwealth of Massachusetts City of Salem This is to Certify that the Pa.ki.ng LOt Building located at Building Type 13 PLANTERS STREET in the City of Salem ......... ..............._..............-................................ . _ ........_.... .......... .... ......,....... .... Address Town/City Name IS HEREBY GRANTED A PERMANENT CERTIFICATE OF OCCUPANCY New Single Family Home SKOMURSKI DEVELOPMENT This Permit is granted in conformity with the Statutes and Ordinances relating thereto, and expires Not Applicable ... ...................... unless sooner suspended or revoked. ......... . .......... Expiration Date Issued On: Thursday, January 14, 2016 Certificate Number: B-15-917 Permit Number: B-15-917 Commonwealth of Massachusetts City of Salem This is to Certify that the ....... ...........-.... ....Pa.r,ki,ng.,L,o.t.,.Blu.i.l.dliln,g.. ll, . ,�,...,.'.."..,..,.,.I........I located at Building Type 13 PLANTERS STREET in the City ........................ ....... --........... -'qf'S�km' --'-............... .......... Address Town/City Name IS HEREBY GRANTED A PERMANENT CERTIFICATE OF OCCUPANCY New Single Family Home SKOMURSKI DEVELOPMENT This Permit is granted in conformity with the Statutes and Ordinances relating thereto, and expires ....... ....... unless sooner suspended or revoked. Expiration Date Issued on: Thursday, January 14, 2016 Commonwealth of Massachusetts City of Salem 3 4 q rr c 120 Washington St,3rd Floor Salem,MA 01970(978)745-9595 x5641 .inuxv na Return card to Building Division for Certificate of Occupancy Permit No. B-15-917 FEE PAID: $910.00 PERMIT TO E:Wn " 1 L rL DATE ISSUED: 10/1/2015 This certifies that SKOMURSKI DEVELOPMENT, LLC has permission to erect, alter, or demolish a building 4713 PLANTERS STREET Map/Lot: 360239-0 W. as follows: New Construction - 1-2 Family CONSTRUCT NEW, SINGLE FAMILY HOME WITH ZBA APPROVAL Contractor Name: Joseph Skomurski t -- i DBA: .. s �' q, Contractor License No: 79854 4 it. �"" 10/1/2015 Building Official Date This permit shall be deemed abandoned and invalid unless the work authorized by this permit is commenced within six months after issuance.The Building Official may grant one or more extensions not to exceed six months each upon written requestI J r) All work authorized by this permit shall conform to the approved application and the approved construction documents for which this permit has been granted. ,tea: All construction,alterations and changes of use of any building and structures shall be in compliance with the local zoning by-laws and codes. t ? ct This permit shall be displayed in a location clearly visible from access street or road and shall be maintained open for public inspection for the entire duration of the work until the completion of the same. The Certificate of Occupancy will not be issued until all.applicable signatures by the Building and Fire Officials:are provided on this permit. s ... .. , H IC#: "Persons contracting with unregistered contractors do not have access to the guaranty fund"(as set forth in MGL c.142A). Restrictions: Building plans are to be available on site. All Permit Cards are the property of the PROPERTY OWNER. U*' �'� Commonwealth of Massachusetts Cityof Salem 720 Washington St,3rd Floor Salem,NA 01970(978)745-9595 25641 Return card to Building Division for Certificate of Occupancy Structure CITY OF SALEM BUILDING PERMIT Excavation PERMIT TO BE POSTED IN THE WINDOW Footing INSPECTION RECORD WA <e Foundation Framing n lO ff Mechanical V / insulation INSPECTION: By DATE Chimney/Smoke Cham er Final jjPlum ing//Gas Rough:Plumbinpo o,,1L`� Rough:Gas �/�`�Li�k� L Final Electrical Service ._. _.....__.. __, tough `A1 2Z v sinal /��VV Fire De artment 'reliminary ` f =in gas {" Health Department 'reliminary =final a Map 36 Lot 240 N/F Donovan 15 Planters St. Iron Pipe S1 4-45'08' (Found) % 76 Iron Rod (Set) — 10.6' 26' I Z Bulk ead w 06 � #13 N 0 01 N 0 rn � cis 1 8.0' � 0 U0 0 - N m 21.3' b Map 36 Lot 234 LOT 1 26.9 N/F 3,886 sq.ft. New England Power Co. `P t17 "E Waite St. Nj4.45'08 54.30 t17 C17 a REFERENCES: 1) Deed Book 5330 Page 476 2) Plan #781 of 1946 3) Plan Book 303 Plan 24 4) Plan #636 of 1955 AS—BUILT FOUNDATION PLAN 5) Deed Book 5618 Page 413 13 PLANTERS STREET SALEM, MASSACHUSETTS Prepared By LeBlanc Survey Associates, Inc. 161 Holten Street Danvers, MA 01923 AH of �Ss9c (978) 774-6012 oma' VERNON yG LeBLANC N September 25, 2015 Scale: 1 "=20' NO. 336 0 HOR. SCALE IN FEET nL 0 20 50 100 mujo 36 ,dal- 239 % 60 S� 3 CITY OF SALEM ROUTING SLIP New Construction h Certificate of �CypAffyuy y f LOCATION DATE ASSESSORS DATE 7ZY 301 93 Washington St. CITY Cl ERK DATE 7`�q- 93 Washingto t. f BLIC SERVICES DATE 0 Washington St. If� ATER 9' DATE 0 Washington St. �jH'�AROSS CONNECTION A�IV" -HATEefferson Ave PLANNING DATE Z S� 120 Washington St. CONSERVATION E 120 Washington St. ELECTRICAL DATE 48 Lafayette t p� FIRE PREVENTION 4�DATE d 29 Fort Avenue HEALTH �— DATE 120 Washington St. BUILDING INSPECTOR---, DATE 120 Washington St. f 1 Map 36 Lot 240 N/F Donovan 15 Planters St. iron Pipe (Found) 56:76' „W S14 4'0 z p J J W O Lor 1 0 CDLp _ 1p 3,886 sq-ft. O O D_ � N 4 Co. 54.30 N14' OS' E I, J J p O W O (P O_ . CD N_ Lor 2 m 3,714 sq.ft. i iTREET 8' 15" Sewer Line--� Sewer 12' Easement 20' Wide — — N 4'4 0 ,i R3 The Commonwealth of Massachusetts CITY OF 1� Board of.Building.Regula[ions and Standards SALEM i QY( I Massachusetts State Building Code, 780M CR ReviseJ,Wv 201ro rr Building Permit Application To Construct, Repair, Renovate Or Demolish a r One-or Ttivo-Fnrnily Dwelling � _ m This Section For Official Use OnlyN r" Building Permit Number: Date Applie . m Building Oiticial(Print N.me)." 8ignalure, - Dore " SECTION 1:S1TE INFOR6IATION to 1.1 Property Address: 1.1 Assessors Map&Parcel Number /� PIAnT� . g•6 L S I.la Is this an accepted street?yes_ no_ Map Number Parcel Numbe Ir 1.3 Zoning Information. I.d Proper ilmensions: ✓ 4-4-2- s` 31j3} Zoning District Proposed Use Lot Area(sq 11) Frontage(it) 1.5 Building Setbacks(R) Front Yard Side Yards Rear Yard ReyuircJ Provided Required Provided Required Provided i0 I 1.6 Water apply:(M.G.L c.d0,§5J) 1.7 Flood Zone Information: 1.8 Sewage DJeposal System: Zone: �• Outside Flood Zone?- Municipal On site disposal system ❑ Public Private❑ Check if yesO SECTIONI: PROPERTYOWNERSHIPL 1.1 OwnerrofRe SKMu r s < A�A44 J O, rIo0 ZQO7 NImic(Print) City,State,ZIP r if_lK� patiucl;,3 I M/'r S�S-96Z-3� � � SKoM��bKf G No,and Street Telephone Email Address SE ION 3: DESCRIPTION OF PROPOSED WORK'(check all that apply) New Construction Wf Existing Building❑ Owner-Occupied ❑ 1 Repairs(s) ❑ Alteration(s) ❑ Addition ❑ Demolition ❑ I Accessory Bldg.❑ Number of Units Other ❑ Specify: Brief Description of Proposed Work: SECTION J: ESTLNA.T.ED CONSTRUCTION COSTS Item Estimated Costs: Official Use Only Labor and Materials) - I. Building S ��D 000 1. Building Permit Fee:$ Indicate how fee is determined: ❑Standard City/Town Application Fee 2. Electrical S 0 1200 ❑Total Project Cost'(Item 6)x multiplier x 3. Plumbing S Q Qa P Qther Fees: S d. %Nchanical (I"IVAC) S List: 5. Mechanical (Fire S Total All Fees:S Su ression) 9 Check No._Check Amount: Cash Amount: 6.Total Project Cwt: S 9 v Cl Paid in Full 0 Outstanding Balance Due: r n SECTION 5: CONSTRUCTION SERVICES 5.1 Construction Supervisor License(CS`L) 5 -0 7-a S'F 3_Z6r1 -I" Jp (� St�OMVYS�( License Number Expiration N:une ul'C^S�L.Ho arrr y,� List CSL'rype(see below) ��"► �" '� T -- Description . No. :n et - Z oq j Unrestricted Buildin s u p to 35,000 cu. It. y rv"k / R Restricted 1&2Famil Dwellin Cityfrown,State,ZIP M Mme RC Roolin Coverin WS Window andSidin I insSoltil Fuel Dtuning Appliances (o ! 1 Insulation Telephone Email address D Demolition 5.2 Registered Home Improvement Contractor(HIC) HIC Registration Number Expiration Date HIC Company Name or HIC Registrant Name No. and Street Email address City/Town, State ZIP kLe hone SECTION 6:WORKERS'.COMPENSATION INSURANCE AFFIDAVIT(M.G.L c.152.§ 25C(6)), Workers Compensation Insurance affidavit must be cognpleted and submitted with this application. Failure to provide this affidavit will result in the denial of the Isjuanc f 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` 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: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 application is true and accurate to the best of my knowledge and understanding. Print Owner's ur Authoracil 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 nut have access to the arbitration t program or guaranty fund under 1I.G.L.c. 142A. Other important information on the HIC Program can be found at Nvvvw mass cov:!oca Information on the Construction Supervisor License can be round at www.mass.eov.!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 Numbcr of bathrooms Number of half/baths 'rype of healing system Number of decks/porches Type of cooling system Enclosed- Open 3. "Total Project Square Footage"may be substituted I'ur"Total Project Cost" The Commonwealth of Massachusetts ��VVYY Deparbnent oflndustrialAcctdents I Congress Street,Suite 100 Boston,MA 02114-2017 www.massgov/dia WWorkers'Compensation Insurance Affidavit:Builders/Contractors/Electricians/Plumbers. TO BE FILED WITH THE PERMITTING AUTHORITY. Applicant Information - Please Print LetdbW Name (Businms/organization/Individual): Mvya fc , (`��ll.G✓�C>�/+•c••'�-- Address: P.0. -zoo r( ' City/State/Zip: �huGfr�._t Phone#: 50�.—Sl% Z—� l� Are you an employer?Check the appropriate box: Type act(required): 1.eiamployer with awkyees(fidl and/or pact-time).• 7. P-1V�1VConSWetion 2. ole proprietor or partnership and have no employees working forme in g- P4,emodelmg any capacity.rNo workers'comp.insorance requited.) 9. ❑Demolition 3.Q I am a homeowner doing all work myself.[No workers'comp.ins mance required.]t 4.Q 1 sin homeowner and will be hiving contractors to conduct all work on my property. twill ME]Building addition. _ ensure that all contractors either have workers'compensation insurance or are sole I LEJ Electrical repairs or additions proprietors with no employees. 'r ' - 12.❑Plumbing repairs or additions 5.r-1 181112 general contractor and I have hired the subcontractors listed on the attached sheer 13. ROOfrtpeirs. These subcontractors have employees and have workers'comp.insurance.[ 6.❑we an,a corporation and its officers hale exercised their right of exemption per MGL c. 14.❑Other 152,§1(4),and we have no employees.lNo workers'comp:insurance requited.) .-Any applicant that checks box#1 must also fill our the section below showing their workers'compensation policy information... . _- t Homeowners who submit this affidavit indicating they ere doing all work and dim hire outside contractors must submit a new affidavit indicating such. ICont actors that check this box must attached an additional sheet showing the name of the sub-contractors and state whether or not those entities have employees. Ifthesub-contractors have employees,they must provide their.workers'.comp.polity.number... I am an employer that is providing workers'compensation insurance for my employees. Below is the polity andjob site information. Insurance Company Name: Policy#or Self-ins.Lic.#: Expiration Date: Job Site Address: City/State/Zip: Attach a copy of the workers'compensation policy declaration page(showing the policy number and expiration date). Failure to secure coverage as required under MGL c. 152,§25A is a criminal violation punishable by a fine up to$1,500.00 and/or one-year imprisonment,as well as civil penalties in the form of a STOP WORK ORDER and a fine of up to$250.00 a day against the violator.A copy of this statement may be forwarded to the Office of Investigations of the DIA for insurance coverage verification. I do hereby i der th it and pen 'es o perjury that the information provided above is true and correct signal •Ulm+ Date: 6 `�7—/ Phone#: S6g� !y Z —351, Official us only. Do not write in this area,to be completed by city or town o,USciaL City or Town: Permit/Llcense# Issuing Authority(circle one): 1.Board of Health 2.Building Department 3.City/Town Clerk 4.Electrical Inspector 5.Plumbing Inspector 6.Other Contact Person: Phone#: c;, /nujo 239 36 bl l3 P��-�-� �l• _% co t S� 3 CITY OF SALEM ROUTING SLIP New Construction by L Certificate of Oc ip icy LOCATION DATE ASSESSORS DATE 93 Washington St. CITY CLERK DATE 7-�9-�S 93 Washingto t. PUBLIC SERVICES DATE 120 Washington St _ WATER DATE '4b IrJm 120 Washington St. /� CROSS CONNECTION ATE 5 Jefferson Ave PLANNING DATE L S� 120 Washington St. CONSERVATION E� I 120 Washington St. ELECTRICAL DATE 48 Lafayette t O� FIRE PREVENTIO<7::jeSj�DATE d 29 Fort Avenue HEALTH DATE 120 Washington St. / � BUILDING INSPECTOR DATE 120 Washington St. 6 Map 36 Lot 240 , N/F Donovan 15 Planters St. Iron Pipe (Found) 56:76 W 514 450 z J J W O LOT �o0 . � 3,886 sq.ft. o N t m E t4 I Co. g4.30 N14l08 E J O O cT t0 , W p LOT 2 m 3,714 sq.ft. �TREET 8' 15" Sewer Line, i Sewer 12' I Easement 20' Wide — _ 4 \, r N1 4�, 83 -FD 3 The Commonwealth of Massachusetts' Board of Building Regulations and Standards CITY OF W WhMassachusetts State Building Code,780 C8 SALEM 0 Devised Mar 2011 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 A ied: Building Official(Print Name) Signature Datk 1 SECTION 1:SITE INFORMATION 1.1 Propqrty Address• <- 1.2 Assessors Map&Parcel Numbers �3 ,t j 6Lid S7. �At t' Xl/ L la 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 pply:(M.G.L c.40,§54) 1.7 Flood Zone Information: 1.8 Sewage D' osal System: Public Private❑ Zone: Outside Flood Zone?Check if yes❑ Municipal 0 On site disposal system ❑ SECTION 2: PROPERTY OWNERSHIP' 2.1 Owner'of Rec d: Name Print) City,State,ZIP i3 E A►s%6So [2 -7� PAKIWs_ G�z�vv��, (�y l�hl. (OA No.and Street Telephone Email Address SECTION 3:DESCRIPTION OF PROPOSED WORW(check all that apply) New Construction❑ Existing Building❑ Owner-Occupied ❑ Repairs(s) ❑ Alteration(s) Addition ❑ Demolition ❑ Accessory Bldg.❑ Number of Units I Other Specify: i t4 Jr : AAS l` Brief Description of Proposed Work : 0 -/l.f UN 1-40 `,0 Ot-- T V 14'" SECTION 4:ESTIMATED CONSTRUCTION COSTS Item Estimated Costs: Official Use Only Labor and MaterialsOCN 1.Building $ U� 1. Building Permit Fee:$ "Indicate how fee is determined: 2.Electrical $ ❑Standard City/Town Application Fee ❑Total Project Cost (Item 6)x multiplier x 3.Plumbing $ 2. Other Fees: $ 4.Mechanical (HVAC) $ List: 5.Mechanical (Fire $ Total All Fees:$ Suppression) f Check No. Check Amount: Cash Amount: 6.Total Project Cost: $ �UVO 0 Paid in Full 0 Outstanding Balance Due: SECTION 5: CONSTRUCTION SERVICES 5.1 Construction Supervisor License(CSL) �� lt -eY 7 ct� 6 Lice censeumN ber ExpiratioA Date Name of CSL Holder ( List CSL Type(see below) U /0 2 9 9-,t ,ol�.�, ,J� No. Street T Description /n��] Q�/_,7� Unrestricted(Buildings u to 35,000 cu.ft (,fi✓)V1�� 144 7 R Restricted 1&2 Fame a lin Cityfrown,State,ZIP M Masonry RC Roofing Covering WS Window and Siding SF Solid Fuel Burning Appliances _��/-�S� y /�a��✓<v��39fcuR�='��`9��Oo CC+1 I Insulation Telephone Email address D Demolition 5.2_Registered Home Improvement Contractor(HIC) & nCU HIC Registration Number Expiration Date HIC Coman am pr HIC R istrant Name 9 0", ./, 1-+w, cc,-o No d Street ---- / AA- , Email ad •ess LI-114 Irl),sco 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 Issuancethe building permit. Signed Affidavit Attached? Yes .......... No...........❑ SECTION 7a:OWNER AUTHORIZATION TO BE COMPLETED WHEN OWNER'S AGENT OR CONTRACTOR APPLIES FOR BUILDING PERMIT I,as Owner of the subject property,hereby authorize S 1D crCc �R,��S to act o half in all matters relative to work authorized by this building permit application. 3- �— 17 Print er's a(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 application is true and accurate to the best of my knowledge and understanding. A Print Owner's or Authorized Agent's Name(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..zov/oca Information on the Construction Supervisor License can be found at www.mass. ov/dps 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"maybe substituted for"Total Project Cost" — 24'2 — -20 - - 3'3 �I I I ,T - Significant Notes: electric c-4-los et 1.Wall Structure:2 x 4 kiln dried members,bottom l plate shall be pressure treated. 2. Finished Ceiling Height:In all areas will be 80 inches or greater. existing egress door 3. Soffits and Duct/Beam Enclosures:In all case shall be 76 inches or greater. 4. Insulation:R-13 Fiberglass with Kraft Paper Vapor barrier. 5. Lighting:Entire living space will be fitted with recessed lighting 6. Doors:All doors shall be a minimum of 30 inches wide and 78 inches tall. _ 7. Finished Wells:Al finished walls and ceiling shall be'%Blue Board treated with a veneer plaster. 8.Fire blocking around perimeter joist and door t0 toraie horizontally every 10 feet on 2 x 4 studs. h r N up j� under stair storage M 00 00 i I Ili i unfinished area I ------------------------------------ -------------------- -------- - --� -� �— — — -------------------------------------------- 23-10 --- - LIVING AREA 549 sq ft