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8 HANSON ST - BUILDING INSPECTION 14s� . z3 Ln , The Commonwealth of Massachusetts CITY OF i Board of Building Regulations and Standards SALEM Massachusetts State Building Code, 780 CMR Revised A%ar 1011 Building Permit Application To Construct, Repair, Renovate Or Demolish a One-or Two-Family Dwelling This Section For.Official Use Only (� BuildingPemitNumber. Daie.Appiied . Building Official(Print Name) - Slgnatura - - Dote SECTION I:SITSINFORAlATION` I.1 Prope ty Address: 11 Assessors Map dal Parcel Numbers sA u v-,©K 1-b4 t I.In Is this an accepted street? es no Map Number Parcel Number 1.3 Zoning Information: 1.4 Property Dimensions: Zoning District Proposed Use. Lot Area(sq R) - Frontage((k) .. . . 1.5 Building Setbacks(R) From Yard._ Slda Ywidr. - Re"YaM' Required Provided Required- P.tovided RegalRd - Provided 1.6 Water Supply':(M.G.L c.40,§54) 1.7 Flood Zone Information' 18 Sewage Disposal`System: Zone Outside Flood Zone? Munici On site dls tem`13 Pablic Private _ Pd I sYs . Chedrif'es0.: SECTION is PROPL[tTYOWNERStIPt 2.1 Ot err of Regio Ile 0) &-C(G (I A Ca-,sibtyte. P " P ZIb �9 �I W OI �17� No. Street Telepbone - Email Address SECTION JOES TION OF PROPOSED WORKs(check all that apply)` New Construction O 6isting Building 15f Owner-Occupied O Repalrs(s) t$ Alterations) O Addition O Demolition O Accessory Sldg.17 Number of Units Other O Specify: Br' Description gf Proposed 1York=: a"I)U retA-F\ �2 t J-. f 1 SECTION 4:ESTIMATED CONSTRUCTION COSTS Itctn - Estimated Costs: - Omeiai Use Only Labor and Materials I. BuildingS lJd� _I. Building Permit Fee:S Indicate how fee is determined: O Standard Cityfrq%va Application Fee 2. Electrical S 8 C00 ❑Total Project Cost'(item 6)x multiplier x J. Plumbing S2?p1her Fees: S 4.Xtechanical (IIVAC) S 1. Ei 00 List: 5.Mechanical (Fire S Su ression) fatal All Fees:S - - Check No. Check Amount: Cash Amount: G. Total Project Cost: S (�O� p Paid in Full ❑Outstanding Balance Due: MAtt_ 12 I1'I -TD , 9V -� SECTION 5: CONSTRUCTION SERVICES $.I Construction Supervisor License(CSL) ccsO!N� .j } `l Si'Lr2License Number Expiration Uak Name of CSL Holder t {� b & If° ST List CSL'rype(see below) No.and S T" Type. Description `yi1570 . U r1 0 15 7nrestricted Build` ft to 33 OW ou. . U`� V I 1© U UR Rrstricled M2 Family Dwelling Citylfoim,State,ZIP M Masonry - RC Roofing Covering WS Window and Sidra SF Solid Fuel Burning Appliances I J/•.L ' lJ;../� ��Jl ./-V-� ,5(tl T tnsutation Telephone Email address D 1 Deawlition 5.2 Registered Home Improvement Contractors(HIC) E"--\tT t6 - tA��r rte HIC Registration Number Expiration Date AA l�C Cympan Nam Cr MIC R;gi! rant Nome and street titA QA3W '2A112c� �r��3 Email address Ci /town State,ZIP Telephone SECTION 6:WORKERS'COMPENSATION INSURANCE AFFIDAVIT(M.G,t►c:152.6 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 Winona of the building permit Signed Affidavit Attached? Yes.......... No...........13 SECTION 76.OWNER AUTHOMUTION TO BE.COMPLETED.WHEN' — , OWNER'S AGENT ORCONTRA CPOItA O&E9FORBUILLDDING.PERIVIIT I,as Owner of the subject property,hereby authorize t t,l tj act on my behalf,in all matters relative to work authorized by this building permit application. aVzvk- �rc�r \1110 -5 Print ihvner's Name(Electronic Signature)ure) 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 or the information contained in this application is true and accurate to the bat of my knowledge and understanding. Print Owner's or Authorized Agent's None(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 m istercd in the Home.lmprovemem Contractor(HIC)Program);will vj have access to the arbitration program or guaranty fund under M.G.L.c. 14 A.Otber'tmport—aoI irifoim—uTionon Ute H1CYrogram can bit`orfii T- — --- www.n uss.gLv'ot�a information on the Construction Supervisor License can be found at tyww mass rov4fus 2. When substantial work is planned,provide the information below: Total floor area(sq.R.) 'r (including garage,finished basement/attics,decks or porch) Gross living area(sq. R.) Habitable room count Number of fireplaces Number of bedrooms Number of bathrooms Number of hatf)baths Type of heating system Number of decks/patches Type of cooling system Enclosed Open J. "Total Project Square Footage"may be substiluted lbr"Total Projuct Cost"