B-17-582 - 0052 BUTLER STREET - Building Permit CKzt � g
' The Commonwealth of Massachusetts
Ty OF
Board of Building Regulations and Standards .,, '? r : , EM
Massachusetts State Building Code,780 CMR Revised Mar 2011
Building Permit Application To Construct,Repair,Renovaln(r I42i2h P
One-or Two-Family Dwelling
- - !'This SeCtton For Octal.USe O;;
[ Bttltftg_Permtt IFtutslier: Date Aphed
l.�
(� wlcl 4tc,a1.'(Prn2t Iatie) Suture Date
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S�C1�ON;:1�SIT'T INFORI!'IATION
1.1 Propery Address: 1.2 Assessors Map&Parcel Numbers
! l A a 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 ft) Frontage(ft)
1.5 Building Setbacks(ft)
Front Yard Side Yards Rear Yard
Required Provided Required Provided Required Provided
FZJJOW�!r
Supply:(M.G.L c.40,§54) 1.7 Flood Zone Information: 1.8 Sewage Disposal System:
Private❑ Zone: _ Outside Flood Zone? Municipal❑ On site disposal system ❑
Check if yes❑
SECTION 2: PRpp�12TY O�NER�l3IPt_
of cord•//-/ lj�¢ City,State,ZIP
�/'��-
No.and Street Telephone Email Address
SECTION I DESCRIPTION OF PROPOSED WORKZ(check all that apply)
New.Construction❑ Existing Building❑ Owner-Occupied ❑ 1Repairs(s) '❑ Alteration(s) ❑ Addition ❑
Demolition ❑ Accessory Bldg.❑ Number of Units Other ❑ Specify:
Brief Description of Proposed Work2:
SECTION 4,ESTIMATED CONSTRUCTION COSTS
Item Estimated Costs: OlT'icial Use Only
(Labor and Materials
1.Building $ 1. Bui)t ng PeJW Fee,.$- indicate how fee is:detenmtned
2.Electrical $ 0 Standard Cst�/1'Qwn A�phcaUan
Q Total Pr�3ed Costa(Iteit 6)x.tnulbplier x
3.Plumbing $ 2: Other Fees. $ .
Y
4.Mechanical (HVAC) $ List d
5.Mechanical (Fire $
Su `ression) Total All Fees:$
Check No. Check Amount: Cash Amount:.
6.Total Project Cost: $ �Glj fj0 ❑Paid in Full ❑Outstanding Balance Due-
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SECTIONS: CONSTRUCTION SERVICES
5.1 Construction Supervisor License(CSL) 1
License Ntunber Expiration Date
N:mie of CSL Holder List CSL Type(see below)
Type- Description ..
No.and Street
U Unrestricted'Buildin L10 to 35,000 cu. R.
R Restricted 1&2 Family Dwelling
City/I'uwn,State,ZIP M Masonly
RC Roaring Covering
WS Window and Sidin
SF Solid Fuel Burning Appliances
1 Insulation
Tele hone Email address D I Demolition
5.2 Registered Ilome Improvement Contractor(HIC)
HIC Registration Number Expiration Date
IIIC Company Name or HIC Registrant Name
No.and Street Email address
City/Town, State ZIP Telephone
SECTION 6:WORKERS'.COMPENSATION INSURANCE AFFIDAVIT(M:G.L..C.I 1250)Y..
Workers Compensation Insurance affidavit must be completed and submitted with this application. Failure to provide
this affidavit will result in the denial of the Isbuance of the building permit.
Signed Affidavit Attached? Yes..........O No...........O
SECTION 76c OWNER AUTHORIZATION-TO 86.COMPLETED,WHEN:'
OWNER'S AGENT OR CONTRACTORAPPLIES FOIE BUILDING.PER&llif
ti
1,as Owner of the subject property,hereby authorize -
t9 act on my behalf,in all matters relative to work authorized by this building permit application.
Print Owner's Name(Electronic Signature) Date
SECTION 7b:OWNEW OR AUTHORIZED AGENT DECLARATION.
entering m name below,I hereby attest under the pains and penalties of perjury that all of the information
B cute g y P ,
Y
contained in is application is tau nd accurate to the best of my knowledge and understanding.
:t Owner's or Authorized Agent's Name(ElCcironic Signature) Date
NOTES:
I. 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 LLoi 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
www.mass.eov/oca Information on the Construction Supervisor License can be found at 4yww.mass._w.!dns .
2. When substantial work is planned,provide the information below:
Total floor area(sq.ft.) N (including gauge,finished basemenNattics,decks or porch)
Gross living area(sq.ft.) Habitable room count
Number of fireplaces Number of bedrooms
Number of bathrooms Number ofhalf/baths
-type of heating system Number of decks/porches
Type of cooling system Enclosed Open
3. "Total Project Square Footage"may be substituted for"Tutai Project Cost"
_ 8 7 6 5 4 3 2 1
D D
+ O O
60in 0
O O O
ASPHALT SHINGLE ROOF '
c c
PUBLIC SIDEWALK
a VINYL SIDING,ALL SIDES ❑ EXTERIOR DOOR
B
STEPS WITH HAND RAIL
168in + ❑ ❑ ❑ ❑
36in 264in
6 CONCRETE FOOTINGS,
4' DEEP MINIMUM
PROPOSED ADDITION SHOWN THIS SHEET. PROPOSED ADDITION A
SEE SHEET 1 FOR EXISTING STRUCTURE 37 BOW ST
DESCRIPTION OF ADDITION:5'X22' PORCH TO BE ADDED TO FRONT SALEM, MA 01970
OF HOUSE.SINGLE EXTERIOR DOOR ALLOWS EGRESS TO RIGHT
OF BUILDING,TOWARD DRIVEWAY.ADDITION TO BE FINISHED WITH, SIZE
MATCHING VINYL SIDING,4 WINDOWS. B DO NOi SCAIEDRAWING SCALE:I:I SO SHEET 20P2
8 7 6 5 a 3 2