1 AMANDA WAY LOT 27 - BPA-11-533 NEW, SINGLE FAMILY 1The Commonwealth of Massachusetts
Board of Building Regulations and Standards CITY
J Massachusetts State Building Code,780 CMR, 7t'edition R O S�ed angary
Building Permit Application To Construct,Repair,Re vate Or Demolish a 1, 2008
One-or -FamilyDwelli
s Sect on For OffictplUse Only
Building Permit Mber: Da Applied:
Signature: 40 IdA;LID
Building Commi caner/Inspector o B ' in Date
SEC N :SITE INFORMATION
1.1 Prope ddr s: r 1.2'AsseW Map&Parcel Nam S.., 43b
1.1 a Is this an accepted street?yes no Map Number Parcel Number
1.3 Zo 'n formatio1.4 Prop rty D'mensions,
Zoning Otsirict Pm�p`osed Use Lot Area(sq ft) Frontage(ft)
1.5 Building Setbacks(ft)
Front Yard Side Yards RearYard
Required Provided Required Provided Required Provided
1.6 Water S ly:(M.G.L c.40,§54) 1.7 Flood Zone Information• 1.8 Sewage Dispo I System:
"Lone: _ Outside Flood Zo
Public Private❑ Check if yes Municipal n site disposal system ❑
SECTION 2: PROPERTY OWNERSHIP'
2Owner'of R ` S �� t. /
N Pr' ) Address for Service:
�-
Telephone
SEC,YION 3:DESCRIPTION OF PROPOSED WORK=(check all that apply)
New Construction T1
Existing Building❑ Owner-Occupied ❑ 1 Repairs(s) ❑ Alteration(s) ❑ Addition ❑
Demolition ❑ Accessory Bldg.❑ Number of UnitsOther ❑ Specify:
Brief Description of Proposed Work 2:
SECTION 4: ESTIMATED CONSTRUCTION COSTS
Item Estimated Costs:
abor and Materials Official Use Only
1.Building $ ,���� 1. Building Permit Fee:$ Indicate how fee is determined:
2.Electrical $ lel
D�.
❑Standard City/Town Application Fee
❑Total Project Cost'(Item 6)x multiplier x
3.Plumbing $ IS .00D, 2. Other Fees: $
4. Mechanical (HVAC) $ List: ` lJ
5.Mechanical (Fire d
Suppression) $ n Total All Fees:$
Check No. Check Amount: Cash Amount:
6.Total Project Cost: $ C-2,101 0t)0 ❑Paid in Full 13 Outstanding Balance Due:
SECTION 5: CONSTRUCTION SERVICES
5.1 Licebsed Construction Supervisor(CSL) �s f �,J
1J� �1G7C' � j C�jltxl License Number' / Expiration Date
A1q&—WC,( (* List CSL Type(see below) (�
Address n Dl 6NO Type Description
U Unrestricted(up to 35,000 Cu.Ft.)
R Restricted 1&2 Family Dwelling
S ` M Masonry Only
i
RC Residential Roofing Covering
elephone a�—Lj (Z( , WS Residential Window and Siding
SF Residential Solid Fuel Burning Appliance Installation
D Residential Demolition
5.2 Registered Home Improvement Contractor(HIC)
HIC Company Name or HIC Registrant Na a Registration Number
Address
Expiration Daze
Signature Telephone
SECTION 6:WORKERS'COMPENSATION INSURANCE AFFIDAVIT(M.G.L.a 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 L S FOR BUILDING PERMIT
er of the subject property hereby
authorize 2 to act on my behalf,in all matters
relative to or autho ' ed by this ding permit application.
S' ature of Owner Date
SECTION 7b:OWNER',VR AUTHO ED AGENT DECCLLA�AAR�RATION
1> '� wn Xo Authorized Agent hereby declare
that the stat en ts and mformatio n the foregoing application are true and accurate,to the best of my knowledge and
behalf. JJ
�O
Pri ame
Signature of Owner or Authorized Agent Date
(Signed under the pains and penalties of perjury)
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
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 110.R6 and 110.R5,respectively.
2. When substantial work is a the information below:
Total floors area(Sq.Ft.) (including garage,finished basement/a ' ,cSkeks or porch)
Gross living area(Sq. Ft.) l - Habitable to count �f
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"
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Professional Land Surveyors Ft Civil Engineers
ESSEX SURVEY SERVICE 1958 - 1986
OSBORN PALMER 1911 - 1970
BRADFORD 8 WEED 1885 - 1972
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PLOT PLAN OF LAND
LOCATED IN
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I hereby certify to the
7ANE:9/ LOT AREA: z'26,5r/2 LOT FRONTAGE: SCC A Aildyng Inspector that the pro-
posed construction shown conforms
FRONT YARD: //7 /i SIDE YARD: f0/' REAR YARD: to the dimensional zoning of
S�Lci1 Mas
SCALE: r
DATE: ICJ ir' G
C i R an
REFERENCE: EK -4 Z PG71? Christop yer R. ME�1;_ PLS 831317 H
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t o.31317 O
104 LOWELL STREET '
PEABODY, MASS.01960 �
(508)531-8121
FAX:(508)531-5920
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Professional Land Surveyors & Civil Engineers
ESSEX SURVEY SERVICE 1958 - 1986
OSBORN PALMER 1911 - 1970
BRADFORD 8 WEED1885 - 1972
PLOT PLAN OF LAND
LOCATED IN
lil SLG%% MASS.
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I hereby certify to the Sfi1Z1
ZONE:R/ LOT AREA: LOT FRONTAGE: L'Cli�f%Z Building Inspector that the pro-
posed construction shown conforms
FRONT YARD: /� h' SIDE YARD: 10rr REAR YARD: to the dimensional zoning of
n
S/dLci Mass
SCALE:
DATE:
M IRT R w\
REFERENCE: 1"' BK `-Yd Z PG 7Cf Christop er R. M11 PLS R31317
�MEL1
`\" No:31317 p
104 LOWELL STREET
PEABODY, MASS.01960
(508)531-8121
FAX:(508)531-5920