68 BEAVER ST - BUILDING JACKET The Commonwealth of Massachusetts
1 Board of Building Regulations and Standards CITY
'y hlassachuscus State Building Code, 73()C'MR, 7"edition of SALEM
L" JJJ Revised Jururury
Building Permit Application To Construct, Repair,Renovate Or Demolish a
One-or Two-Fami1v Dwelling
This Section For Official Use Only
Building Permit Number: Date Applied:
Signature: II s
...._. _� t t �c
1lutlding Co�itatusionerl Inspector of Buildings Date
SECTION 1:SITE INFORMATION
1.1 roperty Address: 5� � 1.2 Assessors Map& Parcel Numbers
' L$Wit!✓�.0
1.1a Il�s this an accepted street?yes v no Map Number Parcel Number
1.3 Zoning Information: 1.4 Property Dimensions:
M Zoning District Proposed Use [,at Area(sq t)) Frontage(R)
1.5 Building Setbacks(R)
Front Yazd Side Yards Rear Yard
Required Provided Required Provided Required Provided
1.6 Water Supply:(M.G.L c.Ja,§54) 1.7 Flood Zone Information: 1.8 Sewage Disposal System:
Public❑ Private❑ Zuni: , Outside Flood Zone? Municipal❑ On site disposal system [ICheek if es❑
SECTION 2: PROPERTY OWNERSHIP'
2.1 Owner``l pof Record:
S�ezrt-?, -5-(
Name(Print) Address for Service:
Signau Telephone
SECTION 3:DESCRIPTION OF PROPOSED WORK'(check all that apply)
New Construction❑ Existing Building OwnerrvOccupied Repairs(s) ❑ 1 Alteration(s) Addition ❑
Demolition ❑ Accessory Bldg.❑ I Number ofUnits__L_ I Other ❑ Specify:
Brief Description of Proposed Work':
SECTION J: ESTIMATED CONSTRUCTION COSTS
ItemEstimated Costs: Omclal Use Only
Labor and Materials
1. Building S 1. Building Permit Fee:S Indicate how site is determined:
2. Electrical S ❑Standard City/Town Application Fee
❑Total Project Cost (Item 6)x mull, her x
3.Plumbing S 2, Other Fees: S
a.Mechanical (IIVAC) S List:
5. Mechanical (Fire S
Su ession) Total All Fees: S
Check No._Check Amount: Cash Amount:_
4.Total protect Cost: S rQt 13 Paid in Ful( 0 Outstanding Balance Due:
SECTIONS: CONSTRUCTION SERVICES
5.1 Licensed Construction Supervisor(CSL)
I.icense Number Fxpiration Date
Name ol'GSI.•I lolder
List CSL Type(see below)
Address MDRIllesidential
Description
1!nrestricted a to 35.0000'u.Ft.)
Signature Restricted l&2 FamilyDwelling
A1ason Only
esidential RoofingCowrin
Telephone esidential Window and Siding
esidential Solid Fuel Burning Appliance Installation
Demolition
5,2 Registered Home Improvement Contractor(HIC)
I IIC Company Name or 11IC 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 of the building permit.
Signed Affidavit Attached? Yes.......... O No...........O
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 to act on my behalf,in all matters
relative to work authorized by this building permit application.
Signature of Owner Date
SECTION 7b:OWNERt OR AUTHORIZED AGENT DECLARATION
1• as Owner 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.
�\ Print Na
Signature of ownef or Authorized Agent Date
Si ed under the pains and penalties of (u
NOTES:
1. An Owner who obtains a building permit to do his/her own work,or an owner who hires an unregistered contract"'
(not registered in the Home Improvement Contractor(HIC)Program),will rro 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 790 CMR Regulations I IO.R6 and I IO.RS,respectively.
2. When substantial work is planned,provide the information below:
Total Hours arca(Sy. Ft.) (including garage, finished basement/attics,decks or porch)
Gross living area(Sq. Ft.) Ilabitable 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 he substituted for"Total Project Cost"
The Commonwealth of Massachusetts
Board of Building Regulations and Standards OFSALEM
CITY
\u / Massachusetts State Building Code, 780 CMR, 7s' edition Revvised Jan ary
Building Permit Application To Construct,Repair,Renovate Or Denolish a 1, 2008
One-or Two-Fancily Dwelling
r' This Section For Official Use Only
r9 �/ B ilding Permit Number: Date Applied: ?
ro Signature: 4eW4 u ✓/o�`l/��
Building Commissioner/Inspector of uildings Date
SECTION 1: SITE INFORMATION
1.1 Pro erty ddress: 1.2 Assessors Map&Parcel Numbers
lo� /J/ _ �f7 PD
I.Ia 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 it) Frontage(ft)
1.5 Building Setbacks(it)
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? Municipal❑ On site disposal system ❑
Check if yes❑
( �g� SECTION 2: PROPERTY OWNERSHIP'2.1/ 'ofReco d � ti•� lad / U �t%7 ) D��1
Address for Service:l �i
�- �FJ ' �d
Signature Telephone
SECTION 3: DESCRIPTION OF PROPOSED WORK' (check all that apply)
New Construction❑ Existing Building❑ Owner-Occupied ❑ Repairs(s) ❑ 1 Alteration(s) ❑ Addition ❑
Demolition ❑ Accessory Bldg. ❑ Number of Units_ Other ❑ Specify:
Brief Descri tionofPro osed ork2:
SECTION 4:ESTIMATED CONSTRUCTION COSTS
Item Estimated Costs: Official Use Only
(Labor and Materials
1.Building $ �0 1. Building Permit Fee: $ Indicate how fee is determined:
2. Electrical $ El 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)
Check No. Check Amount: Cash Amount:
6. Total Project Cost: $/ JVA 60 ❑Paid in Full ❑Outstanding Balance Due:
A
SECTION 5: CONSTRUCTION SERVICES
5.1 Licensed Construction Supervisor(CSL) 6-7 J 3
ZULicense Number Ex iration ate
Name f SL- old
List CSL Type(see below)
Addr s f Ty e Description
U Unrestricted(up to 35,000 Cu.Ft.
tut R Restricted 1&2Fami1 Dwelling
`�}� C/,[////� `,/ M Masonry Only
j RC Residential Roofing Covering
Telephone WS Residential Window and Siding
SF Residential Solid Fuel Burning Appliance Installation
D Residential Demolition
5 Registered Home Improvement Contractor(Inc)� 112(21 . 11m, 9
HIC Compan Name or C Re strant N e _(` Registration Number
(J +J�
Add r _ / /'q�i �V
Expiration Mte
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 Issuan of 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
I, as Owner of the subject property hereby
authorize to act on my behalf, in all matters
re
atwork authorized by this building permit app ' ation.
Si 'Irate`
�S�EC' ION 7b: OWNE�W OR AUTHORIZED AGENT DECLARATION
�YZ �,2X e j- 2)/ Z 4 ,as Owner or Authorized Agent hereby declare
that the statements and�information on the foregoin plication are true and accurate,to the best of my knowledge and
behal
Print
Sigfiaturcof Owner cr Authorized Agent Date
(Signed under the pains and penalties of er'u
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 110.R6 and 110.R5,respectively.
2. When substantial work is planned,provide the information below:
Total floors 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"
7 The Commonwealth of MassachtlSCUS -
�I/ Board of Building Regulations and Standards CITY OF
of
Massachusetts State Building Code, 780 CMR SALEN ail. Revised.11ar 2011
Building Permit Application To Construct, Repair, Renovate Or Demolish a
(hie-or Two-Famih•Dwe(lhkq /
This Section For Offic'• Use Onl
Building Permit Number: D Applied: _
Building Official(Print Namc) Signature Date
SECTION 1: SITE INFORNIATION
1.1 Pr ��yy''ty ddress: 1.2 Assessors hla & Parcel Numbers
�OrY ee,,2 y C t (� p
I.la Is this an accepted street?yes no Map Number Parcel Numtxr
1.3 Zoning Information: 1.4 Property Dimensions:
Zoning District Proposed Use Lot Area(sq II) Frontage(11)
1.5 Building Setbacks(B)
Front Yard Side Yards Rear Yard
Required Provided Required Provided Required Provided
1.6 Water Supply:(M.G.1.c.40,§54) 1.7 Flood Zone Information: 1.8 Sewage Disposal System:
Public❑ Private❑ Zone: _ Outside flood"Lune?Check if yesO Municipal❑ On site disposal system ❑
SECTION2: PROPERTY O ERSHIPI
2 wgg!rl of Re�cord:
Sco7Y /-zi` f/,r vE S Sa°LEhi � p/910
Nmne(Print) City.Stal. ZIP -
�g �<4/EC S� // 97£r-7YS-18Z9
Nu and Street Telephone Email Address
SECTION 3: DESCRIPTION OF PROPOSED WORK'(check all that apply)
New Construction❑ Existing Building❑ Owner-Occupied I: Repairs(s) ❑ Alteration(s) ❑ Addition ❑
Demolition ❑ 1 Accessory Bldg.❑ I Number of Units_ Other ❑ Specify:
Brief Description of Proposed Work': '
-<00--7
SECTION 4: ESTIDIATED CONSTRUCTION COSTS
Item Estimated rStandardCity/Town
Official Use Only
(Labor and \ly
I. Building S uilding Permit Fee: S Indicate how fee is determined:
'. Electrical S ndard City/Town Application Fee
tal Project Cost(Item 6)x multiplier xJ. Plumbing S her Fees: SJ. Mechanical IIIYAC') S _,_at (Fire —:\II Fees: S __No. ('heck Amount: ('ash Amount:
Total Project Cost: S(/O, o/ in Full ❑Outstanding Balance Due:
SECTION 5: CONSTRUCTION SERVICES
5.1 Construction Supervisor License(CSL)
:ucof CSl. Iluldcr
License Num her
---- -- IGpiralinn Date
Nn
List C'SI.1)Pe Uce helowl
No. and Street - ------ - ------ T%; Description
U t 4tmtrictcJ I IIuilJin s u' a>SS,l11W at. Il.l
R Restricted 1&2 Family Dwelling
Cityflown.State.ZIP M Masonry
RC Rooting Covering
- W'S Window and Siding
SF Solid Fuel Miming Appliances
I Insulation -
l'cle hone Finail address D Demolition
5.2 Registered Home Improvement Contractor(HIC)
C'Registration Numlxr Expiration Date
IIIC'Company N;unc or I IIC Registrant Nwnc III
No.and Street Email address
City/Town.State,ZIP Telephone
SECTION 6:WORKERS'COMPENSATION INSURANCE AFFIDAVIT(M.G.L.c. 152.1 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 of the building permit.
Signed Affidavit Attached? Yes .......... O 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
Ito actt an rn behalf, in all matters relative to work authorized by this building permit application.
077A% 1
Print Owner's Narr,e(Electronic Sig alure) 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 or Authorized,\gent's Name(Electronic Signature) Date
NOTES:
I. :\n Owner who obtains a building permit to do his,her own work,or an owner who hires an unregistered contractor
(not registered in the Hume Improvement Contractor(HIC) Program),will not have access to the arbitration
program or guaranty fund under %I.G.L.c. 142A.Other important information on the HIC Program can be found at
w"„s_ncus. ,c oc.i Information on the Construction Supervisor License can be found at ,>>�,�._iu:r<s��A .Ip±
2. When substantial work is planned, provide the information below:
Total floor area(sq. ft.) (including garage, finished bascment'attics,decks or porch)
Gross living area(sq. tl.l _ _ Habitable room count
Number of fireplaces Number of bedrooms
Number of bathrooms Number of half hatls
l'y pe of heating s)Slcm .__ Number of decks, porches
I)pe of Cooling ss stern 17nclosed .__ - --_ _ __ Open
3. "Total Project Square Footage- nnay he Substituted fix-Total Project Cost"
The Commonwealth of MassachuseBs
Board of Building Regulations and Standards CITY
Massachusetts State Building I Code. 780 C'MR, 7'"edition OF SALEM 1 �� Rrvisrrl Jmrrran•
Building Permit Application To Construct, Repair, Ren rte Or Demolish a
One-or Two-Family Dwellin
�I This Seclush Fall O.f&' se Only
J Bu ber .
ilding Permit Num /f D Applied:
Signalure• '�`�"� YJ /0
Huilding Commissioned Inspector of ngs I)ate
SECTION 1:SITE INFORMATION
1.1 4roperty Address: df 1.2 Assessors Map Parcel Numbers
6 d l3FAt CR 'S SQL f ^9•
I.la Is this an acce led street?yes r no Map Number Parcel Number
IJ Zoalag Information: 1.4 Property Dimensions:
Zoning District Proposed Use Lot Arco Isq 11) Frontage(11)
LS Ballding Setbacks(R)
From Yard Side Yards Rear Yard
Required Provided Required Provided Required Provided
1.6 Water Supply:(M.G.1,c.40.5
54) 1.7 Flood Zone tnformatloa: 1.8 Sewage Disposal System:
Public O Private O Zone: _ Outside Flood Zone? Municipal O On site disposal system O
Check if yesO
SECTION2: PROPERTY OWNERSHIP'
2.1 Own�fr of I�«ordn /
0"f7�' 6 lY ff'A✓ze Sr' -"41,p
Name(Pri 1) Address for Service:
�� 'p, 7YS- 2 P2 y
Signature Telephone
SECTION 3: DESCRIPTION OF PROPOSED WORK'(check all that apply)
New Construction O Existing Building O Owner-Occupied O Repairs(s) ❑ Alteration(s) O Addition O
Demolition O Accessory Bldg. O Number of Units Other O Specify:
Brief Description of Proposed Work':L 7�'9peP 44, NRs� ,I/.o.:P p�•�eSyrct
ZN G,`✓i'rr Ror/X A�'4D 3/A•R /4^•f�f f lee i'r �iy:.>i '!Wont
SECTION 4: ESTIMATED CONSTRUCTION COSTS
Item Estimated Costs: Offlelal Use Only
labor and Materials
I. Building Is 1 I. Building Permit Fee:S Indicate how fee is determined:
�. Electrical S ❑Standard City/Town Application Fee
'�60' r7 v O Total Project Costs Iltem 6)a multiplier x
J. Plumbing IS 2. Other Fees: S—�
4. Mechanical (IIVAC) s List:
5. Mechanical (Fire S
Su ression Total All Fees:f
Check No. Check Amount: Cash Amount:
6. Total Protect Cost: S /�Q OQ,0 0 Paid in Full 0 Outstanding Balance Due:
r
SECTIONS: CONSTRUCTION SERVICES
5.1 Licensed Construction Supervisor(CSL)
I.icense Number F[ pimtiun 11ite
Name ul'C'SL I IulJer Liat C'SL Type(see bclowl
f Description
:�Jdress U Urm stricled u to 35,000 Cu.Ft.
R Restricted Id2 FamilyDsvellin
Signuture M M (),tl
RC Residential Rourins Covering
YdepMsrte WS Residential Window and Siding
SF Residential Solid Fuel Burning Appliance Installmiun
D Residential Demolition
5.2 Registered Home Improvement Contractor(HIC)
I IIC Company Na or f IIC Registrant Name Registration Number
Nam
Address Expiration Due
Signature Telephone
SECTION 6: WORKERS'COMPENSATION INSURANCE AFFIDAVIT(M.G.L.c. 152.i 2SC(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 7n:OWNER AUTHORIZATION TO BE COMPLETED WHEN
OWNER'S AGENT OR CONTRACTOR APPLIES FOR BUILDING PERMIT
1 as Owner of the subject property hereby
authorize to act on my behalf,in all matters
relative to work authorized by this building permit application.
Signature of Owner Date
SECTION 7b:OWNEW OR AUTHORIZED AGENT DECLARATION
1 � V ,as Owner or Authorized Agent hereby declare
lbehalf,
hat the s emen d information on the foregoing application arc true and accurate,to the best of my knowledge and
rint Namcignature ol'<)wrter or Authorized Agent Date
Si umkr the nine and naltin of 'uNOTES:
. 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-W have access to the arbitration
program or guaranty fund under M.G.L.c. I42A.Other important information on the HIC Program and
Construction Supervisor Licensing(CSL)can be found in 790 CMR Regulations I IO.R6 and I IO.RS,respectively.
3. When substantial work is planned,provide the information below:
Tutal Moon area(Sq. Ft.) (including garage,finished basement/attics.decks or porch)
Gross living area(Sq.R.) flabitable 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
1. "Total Project Square Footage"may be substituted for"Twal Project Cast"