8 AMANDA WAY LOT 23 - BPA-11-527 NEW, SINGLE FAMILY HOME n The Commonwealth of Massachusetts
1� Board of Building Regulations and Standards CITY
'1 m Massachusetts State Building Code, 780 CMR, 7s'edition O Q ALEMry
d Building Permit Application To Construct,Re iRr,Renovate Or Demolish a 1, 2008
One- Two-Family elling
is ection For £ficial Use Only
Building Pemilt Nu er. ate Applied:
Signature: �� A'dllQ
Building Commissioner/Inspector olTqlVings Date
SEC ON 1: SITE INFORMATION
1 P operty Address• 1.2 Asses rs Map&Parcel Numbers 137
) D3
1.1 a Is this an accepted street?yes no Map Number Parcel Number
1.3 Zoning Information: 1.4/Pnro�pecrty Dimensions:
Zoning District Proposed Use Lot Area(sq ft Frontage
1.5 Building Setbacks(ft)
Front Yard Side Yards Rear Yard
Required Provided Required Provided Required Provided
Q. 6 �l
1.6 Water pply:(M.G.1,c.40,§54) 1.7 Flood Zone Information: 1.8 SewageDiosal System:
Zone: Outside Flood Zo9�?
Public Private❑ Check ifY"sl Municipal On site disposal system ❑
SECTION 2: PROPERTY OWNERSHIP'
2.1 Owner'of Recur
(P t Address for Service:
_ -' rl I- � �Lj -g8g9
zre Telep one
SECTION 3:DESCRIPTION OF PROPOSED WORK=(check all that apply)
New Construction 4Existing Building❑ Owner-Occupied ❑ I Repairs(s) ❑ Alteration(s) ❑ Addition ❑
Demolition ❑ Accessory Bldg.❑ Number of Units I Other ❑ Specify:
Brief Description of Proposed World: -
dr
SECTION 4:ESTIMATED CONSTRUCTION COSTS
Item Estimated Costs:
(Labor and Materials Official Use Only
1.Building $ 1. Building Permit Fee:$ Indicate how fee is determined:
2.Electrical $ �Qo ❑Standard City/Town Application Fee
❑Total Project Cost'(Item 6)x multiplier x
3.Plumbing $ 2. Other Fees: $
4.Mechanical (HVAC) $ List: t�
J
5.Mechanical (Fire , .lam
Suppression) $ //.� Total All Fees:$
Check No. Check Amount: Cash Amount:
6.Total Project Cost: $ QQ� 0 Paid in Full 0 Outstanding Balance Due:
t'
SECTION 5: CONSTRUCTION SERVICES
5.1 Licensed Consfruction Supervisor(CSL)
License Number Expiration Date
f CSL-,Holder List CSL Type(see below)
Address Type Description
(Dal ) nn (� U Unrestricted(up to 35,000 Cu.Ft.)
six?Va �OI� I(� R Restricted 1&2 Famil Dwelling
`i M Masonry Only
RC Residential Roofing Covering
elephoneWS Residential Window and Siding
-751- q VL4LI--)Q2�j SF Residential Solid Fuel Burning Appliance Installation
D Residential Demolition
5.2 Registered Home Improvement Contractor(HIC)
HIC Company Name or HIC Registrant Name Registration Number
Address
Expiration Date
Signature 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 f the building permit.
Signed Affidavit Attached? Yes ..........V No...........❑
SECTION 7a:OWNER AUTHORIZATION TO BE COMPLETED WHEN
OWNER'S AGENT OR CONTRACTOR gPLIES FOR BUILDING PE IT
1, �t��1� `i s as Owner of the subject property hereby
authorize L' to act on my behalf,in all matters
relative ork authorized by thi oil mg permit application.
�
afore of Owner/ Date 6v�,
SECTION 7b:OWNEW OR AUTHORIZED AGENT DECLARATION
1,44elwe 1111er or Authorized Agent hereby declare
that the statements and information on the foregoing application are true and accurate,to the best of my knowledge and
behalf ,
lm
Pri N l r
Signo Owner or Authorized Agent Date
S' ed under the aims and penalties of
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 and
Construction Supervisor Licensing(CSL)can be found in 780 CMR Regulations I IO.R6 and 1 I O.RS,respectively.
2. When substantial work is ph ed, ode the information below:
Total floors area(Sq.Ft.) F (including garage,finished basemenUatt s,decks or porch)
Gross living area(Sq.Ft.) Habitable room count
Number of fireplacesNumber of bedrooms Z
Number of bathrooms i Number of halfibaths
Type of heating system /�— Number of decks/porches
Type of cooling system K&00171al Enclosed Open
3. "Total Project Square Footage"maybe substituted for"Total Project Cost"
Professional Land Surveyors Er Civil Engineers
ESSEXSURVEY'SERVICE. 1958 - 1986
OSBORN PALMER 1911 - 1970
BRADFORD 8 WEED 1885'- 1972
PIAT PLAN OF LAND
LOCATED IN
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I hereby certify
othe &
ZONE: �� IAT AREA:WIOIZI,' LOT FRONTAGE: /1o/GE Building Inspectorthat the pro-
posed construction shown conforms
FRONT YARD: IS�r7 SIDE YARD: 16fi REAR YARD: 3Jo to the dimensional zoning of
/ 5/I2 EW Ma s.
SCALE: —
S�c
DATE: Pzz �. zc/�//L 1 Y ER
REFERENCE: BK 7G Z PG /7 Chris opher R. Me12 PL5EN317
,Q No.31317 Q
GIs Q�
104 LOWELL STREET
PEABODY, MASS. 01960
(508)531-8121
FAX:(508)531-5920