The URL can be used to link to this page

5 DALTON PARKWAY - BUILDING PERMIT APP The Commonwealth of Massachusetts CITl OF Board of Building Regulations and Standards SALEM Massachusetts State Building Code,780 CMR tt�y, ``-,,,,r(; � eW.e ar 2011 T— Building Permit Application To Construct,Repair,Renovate OPi9e81'dliA 1 _ ��- One-or 7Evo-Family Dwelling j This S,ectim For OffclalUse Only t Building Pe.ujft Number . !DateApplied: 'S zS Ib rla�gots (rNami9 sigma ---- C SETION 1:srrE IN OTtMATION 11Pro rty Address- �^R��-A 1.2 Assessors Map&Parcel Numbers , 1.1 a Is this an accepted street?yes_ no Map Number Parcel Number 13 Zoning Information: 1.4 Property Dimensions: Zoning District Proposed Use Lot Area(sq R) 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: Zone: _ Outside Flood Zone? Municipal❑ On site disposal system ❑ Public❑ Private❑ Check if es[3 SECTION 2: PROPERTY OWIVERSHIPt 2,L Owner'of Record: ! � 1l 1Z IZ y lX Iy(2S't-10111 City, SState,`ZIP Name DA-ITQI^/ PA-►Zf��i-y t — 7� No.and Street Telephone Email Address SECTION 3-DESCRIPTION OF PROPOSED WORK;(Ph eck all that aPPly) New Construction❑ Existing Building❑ Owner-Occupied [3Repairs(s) ❑ Alteration(s) ❑ Addition ❑ Demolition ❑ Accessory Bldg.❑ Number of Units_ I Other ❑ Specify SITZ 1 P iln ctP Brief Description of Proposed World: Zh,b SECTION 4:ESTIMATED CONSTRUCTION COSTS Estimated Costs: Official Use Only . Item (Labor and Materials 1.Building $1 D X 00 f�© I Btdlding Permit Fee,.$ indicate how fee is determined; ❑Standard City/Town Application Fee 2.Electrical $ O Total Project Cost'(Item 6)x multiplier x 3.Plumbing $ 21 Other Fees: 4.Mechanical (HVAC) $ List: 5.Mechanical (Fine $ Total All Fees:$ Suppression) Check No. Cheek Amount: Cash Amount. 6.Total Project Cost: $ L Qt Q Ot7,ab 13 Paid ut Full [IOutstanding Balance Due. . SCN� qO 21 �j SECTION 5: CONSTRUCTION SERVICES 5.1 Construction Supervisor License(CSL) Ito/ 9-'7`V Q License Number Expiration Date Name of CSL Holder 2-1 `_ V e )'wa�) S-rl1P e7 List CSL Type(see below) AE— No.and Street 0a L4/1V1111- �� /1 odo U Unrestricted uildin to 35000 w.ft. L 4 /7 / R Restricted l&2 Family Dwelling City/fown,State,ZIP M Masonry RC Roofing Covering WS window and Siding **��'� SF Solid Fuel Burning Appliances I S47f L94 1 I Insulation Telephone Email address D Demolition 5.2 Registered Homey Improvement JCo—nettrractor(HIC) Sn , A)-T L P\ 1 /Y'tlf „ t A • HIC Registration Number Expiration Date C Re t pm ,/Z�N�HIN/^� �y�Y"la'me • NIIY AStreet Email address -/L r ' Y7 l��( 0 7 I�� ', Ci /Town State,ZIP Telephone SECTION&WORIUMV COMPENSATION INSURANCE AFFIDAVIT(NLG.-c.In§ 25iC(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 .......... No...........❑ SECTION 7a OWNER AI7THORIZA tKV TO BE COIVIPLETEI)WHEN OWNEWS AGENT RCO G'T .R A"IIE$.FQRRt [l"IINNG \ / I,as Owner of the subject property,hereby authorize `r” Z6-/ � M J/ /T"rr"�>• to act on my behalf,in all matters relative to work authorized by this building permit application. See 691-`-TNA-C7t' 46-��(o Not Owner's Name(Electronic Signature) Date SECTION 76:OWNEW 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 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 3nnm1ass.gov'oca Information on the Construction Supervisor License can be found at Mm2y.mass.gov/dos 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'