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B-17-1065 - 0029 UPHAM STREET - Building Permit ' $[Otllo CK 1oz r. 4 The Commonwealth of Maps h ` _ '.: is ,." 3 �t j. ida-gt ras`• ` FOR Board of-Building Regulitions an�l-Stallzia�ds y. MUNICIPALITY State Building 11 Code,780 CM��R USE Building Permit Application To Construc>,�R� ) eQovate Oi) emolish'a t Revised Mar 2011 ''nn One-or Two Family Dwelling , This Section For Official Use Orily Building Permit Number Date 1 Building Official(Print Name) Signature Date : SECTION 1:SITE INFORMATION W Addres 1.2 Assessors Map&Parcel Numbers an accep ed 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 1.6 Water Supply:(M.G.L c.40,§54) 1.7 Flood Zone Information: 1.8 Sewage Disposal System: WNbPrivate❑ Zone: _ Outside Flood Zone?# Municipal❑ On site disposal system ❑ Check if yes❑ SECTION 2: PROPERTY OWNERSHIP' 'o .R cord: ,a City,State,ZI Pq 8 $ pai o � �qrl No.and Street Telephone Email Address i SECTION 3:DESCRIPTION OF PROPOSED WORKZ(check all that apply) New Construction❑ Existing Building❑ Owner-Occupied ❑ Repairs(s) ❑ Alteration(s) ❑ Addition ❑ Demolition ❑ Accessory Bldg.❑ Number of Units Other ❑ Specify: Brief Description of Propose ork2: SECTION 4:ESTIMATED CONSTRU TION COSTS Item Estimated Costs: Official Use Only Labor and Materials 1.Building $ 1. Building Permit Fee:$ Indicate how fee is determined: 2.Electrical $ ❑Standard City/Town Application Fee ❑Total Project Costa(Item 6)x multiplier x 3.Plumbing $ 2. Other Fees: $ 4.Mechanical (HVAC) $ List: -5.Mechanical (Fire Suppression) $ Total All Fees:$ Check No. Check Amount: Cash Amount: 6. otal Project Cost: $ I�t 03 Q-OO 13 Paid in Full 13 Outstanding Balance Due: . I > SECTION"5 .CONSTRUCTION SERVICES 5.1 Constr ction Su ervi or License(CSL) 1zn ®� k4 �1(, License Number -Expfrati6n Date Name of CSL Holder L4 P� � List CSL Type(see below) p' r4 Type Description No.and Str t Unrestricted(Buildings u to 35,000 cu.ft. 7L I R Restricted 1&2 Family Dwelling City/Town,State,tip M Masonry RC Roofing Covering WS Window and Siding QIn A p /, SF Solid Fuel Burning Appliances i LL6 1 �G( (eAwl I Insulation Telephone Email address D Demolition 5.2 Re/giister d Home I �mprovement Contractor(HIC) ekhye `/m�A m 4 HIC Registration Number 'Expifation Date HIC Company Name or HIC Registrant Name 9K- AA&gi'm ktim Q4 Gcre en 4i+,,g No.a d S t V Email add s feat ok /ip e // Ci own,Stlte,ZIP 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 .......... No...........❑ SECTION 7a:OWNER AUTHORIZATION TO BE COMPLETED WHEN OWNER'S AGENT.OR CONTRACTOR APPLIES //FO fR BBUILDING PERMIT. I,as Owner of the subject property;hereby authorize CrGav2 C�tc I ►did to act on my behalf,in all matters relative to work authorized by this building permit application. �ai�-1 41A ID �� /7 Print Owner's Name(Electronic Signature) 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. - 4W Akvx ' to/31a 1 Print Owner's or Authorized Agent's Name(Electronic 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 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 www.mass. og v/oca Information on the Construction Supervisor License can be found at www.mass.gov/dps 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"maybe substituted for"Total Project Cost" i Site Plan File No. Salem29upham Loan# 292-675-170 Borrower Jawaid B Patricia Awan Property Address 29 Upham Street City Salem County Essex State MA Zip Code 01970-1302 Lender/Client Salem Five Mortgage Company,LLC Address 210 Essex Street,Salem,MA 01970 I i i t r Liy R/Q OF y osz R. Th'c.So7" z9 H_ R"-557. .:J;04 Est!!iVt�Stss. is I ¢tam I I. Lu:x`8 I � g Lot i ��'� d'azrtib'.sr+�crii,��ordl !f ai+ r� nos >ira on wa3 _ . r Lwab sjy of firms•. i i { I I i { UAD Version 9/2011 Produced by ClickFORMS Software 800-622-8727 Pape 14 of 35 Floor Plan File No. Salem29upham Loan# 292-675-170 Borrower Jawaid&Patricia Awan Property Address 29 Upham Street City Salem County Essex State MA Zip Code 01970 1302 Lender/Client Salem Five Mortgage Company LLC Address 210 Essex Street Salem MA 01970 i i 1 WeOrm Page 1 of 1 I t4FA i F i I 1mpJtsaleni patri prO p2ties.coillictuteV ew asp?IMG=sketcb/6000/562001 jPg- t 1Y25/Z©16 I i i UAD Version 9/2011 Produced by ClickFORMS Software 800-622-8727 Page 15 of 35 ` f Floor Plan File No. Salem29upham Loan# 292-675-170 Borrower Jawaid&Patricia Awan Property Address 29 Upham Street City Salem County Essex State MA Zip Code 01970-1302 Lender/Client Salem Five Mortgage Company LLC Address 210 Essex Street Salem MA 01970 i i weorro Page I of 1 i YJ OF jg i -7 •13. _••er1 i I 1 �JU V ,X .18 7 i Y 1 i j i j I hap' P� vroperties ctweview.asp2II G—.ketcl MW156200 1JR. 11l25/2016 I � i UAD Version 9/2011 Produced by ClickFORMS Software 800-622-8727 Page 16 of 35