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38 ESSEX ST - BUILDING PERMIT APP The Commonwealth of Massachusetts Board of Building Regulations and Standards CITY ee Massachusetts State Building Code,780 CMP, 7'edition OF SALEM Building Permit Application To ConsIm Revised January One-or Two-F Renovate Or Demolish a 1,2008 ,Aily Dw�ffing 7, -77— 77 010 rm it''N .'3ignatttre -Iran -00 POO xoflimldhsgsc"' 77� V 1.2 Assessors Map&Parcel Numbers Lla 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 F) Frontage(ft) 1.5 Building Setbacks(1t) Front Yard Side Yards Rear Yard Required Provided Required Provided Required T—Provided 1.6 Water Supply: (M.G1 c.40,§54) 1.7 Flood Zone Information: 1.8 Sewage Disposal System: Public 13 Private 13 Zone: Outside Flood Zone? Municipal 13 On site disposal system 0 Check if yes13 -777", -1 W- W W. �"W #0 7,77, 2.1 Owne of Record: 4 Y 'es 3 K Name(Pfint) Address for Service: Klr�>- CI)14-V 9?k Si Teleplione t-that apply) New Construction E3 Existing Building 13 Owner-Occupied [3 Repairs(s) 0 Alteration(s) 13 Addition 0 Demolition 13 Accessory Bldg. 13 Number of Units Other 0 Specify: Brief Description of Proposed Work': SECTION 4:E$T�Wt JC � , �X� ,T] Item Estimated Costs: -,0 (Labor and Materials) A -941,ldifti ,i'Aff,pba' 'I di ' h 1.Building $ _6 It icate owfee is.determined: 2.Electrical tdad e ulte IeF x 7 u 3.Plumbing $ 1N- 4.Mechanical (HVAC) $ IMW 5.Mechanical (Fire Suppression $) k -.Amount-, Cash Amount: 6.Total Project Cost: $ 4 Outstanding Balance Due: 5.1--Licensed Construction Supervisor(CSL) Mme/ P L 'L, rf A-� License Number Expiration Date Name of CSL-Holder List CSL Type(see below) LI/ r%y/JOAU f�S "tion, Address °A �O ,( n _ U Unrestricted(up to amity35,000elling R Restricted l&2Famil Dwelling Signature M Masonry Only s RC Residential Roofing Covering Telephone WS Residential Window and Siding SF Residential Solid Fuel Burning Appliance Installation D Residential Demolition 5.2 Re 'stere H e I prove tent ContraGtorrIC) /D y�_ HIC Corftpan Name or C Re ' r t me GG.. Registration Number G� Date c �S Address �Q Expiration Signature / Telephone SFCPIONb WORT{EIZSr CQMPENSga1 I0 II U}tANCE 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 .......... No...........❑ SECIIQl�17a:OlgERvli1>IiU1AIgr; 1IES AB r `_- OWNER'S,AGENT`t)R;CONT'RXGTO i�Pl!F: I{�B. IN�s=AE % .; A J I G Y as Owner of the subject property hereby authorize `�' cJr to act on my behalf,in all matters relative to work autho ized by this buil ' permit application. "- Si na of er Date SEC1I©N7�,OWNFIi', R§IJ . $, ZEDrrt )`TfiIS)CLAttAT[QN as Owner or Authorized Agent hereby declare that the statements and informatiorron the foregoing application are true and accurate,to the best of my knowledge and behalf. L Print Name Signature of Ovvner or Authorized —� Date - Si red order the stns and enaltres of e u �t(� 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 importantinformation on the HIC Program and Construction Supervisor Licensing(CSL)can be found in 780 CMR Regulations l IO.R6 and 1IO.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"maybe substituted for"Total Project Cosy'