Loading...
57 BARSTOW ST - BPA-16-875 2ND FL BATH InS c I I S The Commonwealth of Massachusetts ITY OF =` Board of Building Regulations and Standards" .: '�( 1ALEM Massachusetts State Building Code, 780 CMR �r Revised Mar 2011 Building Permit Application To Construct,Repair, Renov&bDA*nn$isA 4 EI One-or Two-Family Dwelling ( n - This Section For Official Use Only r Building Permit Number: DateApplied: (41-1 ✓ V NLb 1 Building Official(Print Name) Signature Date SECTION 1:SITE INFORMATION I Ll Pr�o7pet AddrtZs: 1.2 Assessors Map&Parcel Numbers rl- I.1 a Is this an accepted street?yes no Map Number Parcel Number l 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 Supply:(M.G.L c.40,§54) 1.7 Flood Zone Information: 1.8 Sewage Disposal System: Public❑ Private❑ Zone: _ Outside Flood Zone.,Check if yes❑ Municipal❑ On site disposal system ❑ SECTION 2: PROPERTY OWNERSHIP' 2.1 Owne'' fRecord; - r_ 'a Name(Print) A City,State.ZIP �.. S, R,� .Sos - M�IISc 1 n a.C� No.and Street Telephone ma it Ad rens SECTION 3:DESCRIPTION OF PROPOSED WORK'(check all that appl ) New Construction❑ Existing Building❑ Owner-0ccupied ❑ Repairs(s) ❑ Alteration(s) ❑ Addition ❑ Demolition ❑ Accessory Bldg. ❑ Number of Units Other ❑ Specify: Brief Description of Proposed Work 2: Nd I SECTION 4:ESTIMATED CONSTRUCTION COSTS Estimated Costs: Item Labor and Materials) Official Use Only 1.Building $ SCO(1 1. Building Permit Fee: $ Indicate how fee is determined: «.4r ❑ Standard City/Town Application Fee 2.Electrical $ �� � ❑ Total Project Cos['(Item 6)x multiplier x 3.Plumbing $ l] 7�� 2. Other Fees: $ 4.Mechanical (HVAC) $ List: 5. Mechanical (Fire $ Suppression) Total All Fees:$ i 7Check No. Check Amount: Cash Amount: 6. Total Project Cost: ❑Paid in Full ❑ Outstanding Balance Due: /a l I_ To Co tJ7 'R SECTION 5: CONSTRUCTION SERVICES 5.1 Construction Su ervisor License(CSL) e� License Number Expim[io Date Name of CSL Holder _. _ '^� n h ut���ty L � List CSL Type(see below) W lkd— t 1 1 0 T Type Description No.and Street �-7 t ©/ ( / U Unrestricted Buildm n up to 35,000 cu.ft.) R Restricted t&2 Family Dwelling City/Town,State. IP M Masonry RC Roofing Coverin WS Window and Siding p ) 5`4 /L/ `/ qy� l jebo VS2-Se-1✓✓Kits SF Solid Fuel Burning Appliances 79 l 5 6 7 U �J a aftlar' '" b I Insulation Telephone Email address D Demolition 5.2 Registered Home Improvement Contractor(HIC) j , /.2 2 : / 4 Zrf 1 &�4'�i(.,(LQ &IL.-li WWJ L_� L HIC Registration Number Expiration Date HICComiliany Name or HIC Regstra Name lMr�wJy1 —�1 jt-k- t)v,re-5@c. pthhiis and trees°t Email address � CJ/Town,S te,ZIP Tele hone SECTION 6:WORKERS' COMPENSATION INSURANCE AFFIDAVIT(M.G.L.c 152.§ 25C(6)) kers Compensation Insurance affidavit must be completed and submitted with this application. Failure to provide affidavit will result in the denial of the Issuance of the building permit. Signed Affidavit Attached? Yes .......... No........... 0 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 h t71rf s}< ge%r LLC to act on my behalf,in all matters relative to work au t onzed by this building permit application_ Print Owner's ame(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 and accur to the best of my knowledge and understanding. 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 Information on the Construction Supervisor License can be found at 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"may be substituted for"Total Project Cost" �; i Massachusetts Depa u{arioIt nsfand Sliac t SS ndaee rtt ds Board of Building Reg iIss mm license: CS-09528U or } Construction Supe ROBERT A PIERCE 6T MONUMENT AVENUE, SWAMPSCOTT MA 010 Wi- Expiration: ^^� 0311312018 Commissioner i� II{j Clfe.�anurrrawuieallf r�C�/�aataT/zuanQa Office of Consumer Affairs&Busmess Regulation I HOME IMPROVEMENTCONTRACTOI Re0istrationn:`�i42}2824 Type: Expiratio _✓. k18 Ltd Liability Corpor LITE HOUSE SERtE (f' ROBERT PIERCE 67 MONUMENT AVE F SWAMPSCOTT,MA 01907 1"' Undersecretary YT