6 ALMEDA ST - BPA-15-1382 REPAIR FRONT STAIRS �$2`s 40 GK iI Z.'Z
t 9 The Commonwealth of Massachusetts CITY OF
Board of Building Regulations and Stp»dards
"r�r SALEM
0 1 Massachusetts State Building,fYq M Ed �(r c Revtre� JkAr1011
Building Permit Application To Construct, Repair, Renovate Or Demolish a
One-or Two-F,=Ily DIM#hMr
This Section For Official OWN&-
Building Permit Number Date Applied.
Building otTiciat(Print Name} St I!r I��
g�n!c: Date
DO SECTION I SITE INF'Otti"Murotq.
I.l Property Address:_
kL rn E O A- 1.2 Assessors Map&Parent Numbers
(� ^5T .
h Tla is this an ecce ted srreetr es ✓ »o Map Number Parcel Number
l I.) Zoning Information: 1.4 Property Dimensions:
ZuningDisWct Proposed Use WArm(sq it) Fwatage(0)
1.3 Building Setbacks(R)
Frain Yard Side S'mtb Rear Yard
C Requbed Provided
. Required Providal Required' Provided
1.6 Winter upply:(M.G.L c:40,§54) 1.7'Fktod Zone lsdbrmattone 1.$Sewage Dts Isysteai:
Public Private Zone Out WeFloodZon�2 MwtFdpci d ��serm a
SECTIgNI: PROPE.ttarl?�VNBRSFCIPw,
i.l Owner'of Record:
r t-
"no s-r t l^rr# 5'RRz Ea F In A o (9-o
Nene(Print? - Cuy:state,ZIP
z�� 61� 3 is l-44
No.earl stmt .4
- Finail Addnxs
SECTIO J:DESCRIPTION OF PROPOSED IVORIO(cheek
all that apply)
NewConstntctiat Q i kisting Building 0 Owuer-0coupied O Repairs(s)W AFteration(s) t3 Addition 13
QemolFtFan 13 Accessory Bldg !] NumberofUnittI Other !] Specify:
Brief Descriptiono Proposed Work ;
SECTION at ESTIMATED CONSTRUCTION COSTS
hcm Estimated Costs: Official Use Only
Labor and Niateriats y
1. Building $ 3 o L 8Witting Permit Fee:f Indlcatehow fee is determined:
2. Electrical S O Standard ChylTown Application Fee.
D Total Project.Cose(Item 6)r multiplier r
3.PFmnbing Sq013
P PtherFees: S
4.Alcchanirai (HVAC) S List:
S.hh:chamcal (Fire S 1
Su ression) Total All Fees:S
Check No. Check Amount: Cash Amounts
6, Total Project Cost S 3 Paid in Full 13 Outstanding Balance Due:
SECTION s: CONSTRUCTION SERVICES
5.1 Construction Supervisor License(CSL)
i
License Number Expiration Date
Name of CSL Holler
List CSL'rype(see below)
No.and Street Type. Descriplioa
U Unrestricted(Buildings no to 35.000 cu.ft.)
R Restricted 1&2 Family Dwelling
C ityfrovn.State,ZIP M M
RC Roorinit Covering
WS window and Siding
SF Solid Fuel Burning Appliances
1 Insulation
Tclephow Email address D I Demolition
5.2 Registered Home Improvement Contractor(HIC)
I IIC Company Nemo or HIC Registrant Name HIC Registration Number Expiration Date
No.and Street Email address
Ci frown State ZIP Telephone
SECTIONbrWORKERS'.COMPENSATION IN$URANCE'AFFIDAVIT(MG;L.c;t$2 �2$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 Issuance of the building permit.
Signed Affidavit Attached? Yes..........O No...........O
SECTION lot OWNER AUTHORIZATION TO BE.COMPLETED.W HEM ,,".
OWNER'S AGENT OR CONTRACTOILAPPLIES FOR,BUILDING.PERMIT
1,as Owner of the subject property,hereby authorize
t j 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:OWNERI OR AUTHORIZED AGENT DECLARATION
By entering my name below,i hereby attest under the pains and penalties of perjury that oil of the information
contained in this application is true and accurate to the best of my knowledge and understanding.
(Electronic
Print Owner's or Authorized Agent's Name 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
_ (no registered in the Home Improvement Contractor(HIC)Progmmj will LW have access to the arbitration
program or guaranty Rind underIvI.6.L,c. 142A.Oihei important inform—alttoo on the MC'Pro(,ram can o d aC" — -
www.m;tss.0 v.'oca information on the Construction Supervisor License can be Found at ww�}.mass.eovtdns
2. When substantial work Is planned,provide the information below:
'roal floor area(sq. ft.) N (including garage,finished basement/attics,decks or porch)
Bross 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'"rotas Project Cost"