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IE'r �� •;tN �.�,�re.J �� � t f1 - uE4U !(f(�Utr1 d00A'- '*t N o L. - --_ _ _ --. _ - -, - -,. � GJu�l�y r9x'1✓V i1:+-if )1 .. r 1 n- No. City of Salem Ward 3-1 APPLICATION FOR PERMIT TO BUILD ADDITION, MAKE ALTERATIONS OR NEW CONSTRUCTION IMPORTANT-Applicant to complete all items in sections:1, II, /it, IV,and IX. I. V AT(LOCATION) 2 Botts Court ol°NINICT R-2 LOCATION (NO.) (STREET) OF BETWEEN Chestnut Street AND Essex Street BUILDING (CROSSSTREET) (CROSS STRTETI D SUBDIVISION LOT BLOCK SIZE II. TYPE AND COST OF BUILDING -All applicants complete Parts A -D A. TYPE OF IMPROVEMENT D. PROPOSED USE•FOR"DEMOLITION"USE MOST RECENT USE 1 ❑ New building Residential Nonresidential 2 ❑ Addition(If residential,enter number of new 12 ® One family 18 ❑ Amusement,recreational housing units added,it any,in part D,13) 19 [-] Chruch,other religious 13 E] Two or more family-Enter number 3 ❑ Alteration(See 2 above) of units ....................................................... 20 ❑ Industrial 21 ❑ Parking garage 4 ® Repair replacement 14 ❑ Transient hotel,motel,or dormitory- Enternumberof units ........................... 22 ❑ Service station,repair garage 5 ❑ Wracking(it multifamily residential,enter number 23 ❑ Hospital,institutional of units in building in Part D, 13) 15 ❑ Garage 24 ❑ Office,bank,professional 6 ❑ Moving(relocation) 16 ❑ Carport 25 ❑ Public utility 26 E] School,library,other educational 7 ❑ Foundation only 17 ❑ Other-Specify 27 ❑ Stores,mercantile B.OWNERSHIP 28 ❑ Tanks,towers 8 ❑ Private(individual,corporation,nonprofit institution,etc.) 29 ❑ Other-Specify 9 ❑ Public(Federal,State,or local government C.COST (Omit cents) Nonresidential-Describe in detail proposed use of buildings,e.g.,food processing plant, machine shop,laundry building at hospital,elementary school,secondary school,college, parochial school,parking garage for department store,rental office building,office building 10. Cost of improvement ......................................................... $ 20,000 at industrial plant If use of existing building is being changed,enter proposed use. To be installed but not included in the above cost a. Electrical-......................................................................... 10,000 b. Plumbing.......................................................................... 3 , 000 c. Heating,air conditioning d. Other(elevator,etc.).................-.................................. 11. TOTAL COST OF IMPROVEMENT is 43 ,000 W. SELECTED CHARACTERISTICS OF BUILDING -For new buildings and additions, complete Parts E-L;demolition, complete only Parts J&M, all others skip to IV E. PRINCIPAL TYPE OF FRAME F. PRINCIPAL TYPE OF HEATING FUEL G. TYPE OF SEWAGE DISPOSAL I. TYPE OF MECHANICAL 30 ❑ Masonry(wall bearing) 350 Gas 40 Q Public or private company Will there be central air 31 Q Wood frame 36 ❑ Oil 41 ❑ Private(septic tank,etc.) conditioning? 32 ❑ Structural steel 37 ❑ Electricity 44 ❑ Yes 45 ❑ No 33 ❑ Reinforced concrete 38 ❑ Coal H. TYPE OF WATER SUPPLY Will there by an elevator? 34 ❑ Other-Specify 39 ❑ Other-Specify 42 ® Public or private company 46 ❑ Yes 47 ❑ No 43 ❑ Private(well,cistern) J.DIMENSIONS M. DEMOLITION OF STRUCTURES: 48. Number of stories .... ........... 3 49. Total square feet of floor area, a0 floors,based on exterior Has Approval from Historical Commission been received dimensions ........................................-............................... ,7 9 4 • 7 5 PP for any structure over fifty(50)years? Yes_ No_ 50. Total land area,sq.It............................-........................ 3, 581 Dig Safe Number K.NUMBER OF OFF-STREET PARKING SPACES Pest Control: 51. Enclosed ......................................................-..................... HAVE THE FOLLOWING UTILITIES BEEN DISCONNECTED? 52. Outdoors............................................................................. 2 Yes No L RESIDENTIAL BUILDINGS ONLY Water: 53. Enclosed..........................................................-................. Electric: Gas: Full......._...._.._2...................- Sewer: 54. Number of bathrooms PeDOCUMENTATION FOR THE ABOVE MUST BE ATTACHED Partial............_1..................... BEFORE A PERMIT CAN BE ISSUED. IV. COMPLETE THE FOLLOWING: Historic District? Yes No_ /(If yes, please enclose documentation from Hist. Com.) Conservation Area? Yes_ NoJL (If yes, please enclose Order of Conditions) Has Fire Prevention approved and stamped plans or applications? Yes_ No_ Is property located in the S.R.A. district? Yes_ No Y Comply with Zoning? Yeses[ No (If no,enclose Board of Appeal decision) Is lot grandfathered? Yes_ Nom (If yes, submit documentation/if no,submit Board of Appeal decision) If new construction, has the proper Routing Slip been enclosed? Yes_ No Is Architectural Access Board approval required? Yes_ No-47 (If yes,submit documentation) Massachusetts State Contractor License# Salem License # Home Improvement Contractor# Homeowners Exempt form (if applicable) Yes Y No CONSTRUCTION TO BE COMMENCED WITHIN SIX (6)MONTHS OF ISSUANCE OF BUILDING PERMIT If an extension is necessary,please submit CONSTRUCTION IS TO BE COMPLETED BY: July 1994 in writing to the Inspector of Buildings. V. IDENTIFICATION - To be completed by all applicants Name Mailing address-Number,street,city,and state ZIP Code Tel.No. Usovicz 2 Botts Court Salem, MA 44-3182 Owner or Lessee 01970 2. Contractor Builder's License No. 3. James BAllou 14 Cambridge Street Salem, MA 745-1354 Architect or Engineer I hereby certify that the proposed work is authorized by the owner of record and that I have been authorized by the owner to make this application as his authorized agent and we agree to conform to all applicable laws of this jurisdiction. Signature of applicant Addresl� Botts Court Salem, MA 0197 Application date 7-7-93 DO NOT WRITE BELOW THIS LINE VI. VALIDATION Building �,/�_ FOR DEPARTMENT USE ONLY Permit number 7 BuildingUse Group Permit issued ��Gl eP 1-7 19 q3 Fire Grading Building Permit Fee $ �b.'S [ KR cit Live Loading Certificate of Occupancy $ Approved by: occupancy Load Drain Tile $ Plan Review Fee $ ( 1 l a TITLE NOTES AND Data• (For department use) Reconstructing interior of the property with remodeled and new bathrooms, remodeled Kitchen , reconstruction and enclosure of porch. Installing new heating system (changing furnance from oil to gas) Upgrading service inthe house and new wiring throughout the house. Installing sorm windows and new windows in family room, staircase and Kitchen. PERMIT TO BE MAILED TO: DATE MAILED: Construction to be started by: Completed by: VI ZONING PLAN EXAMINERS NOTES DISTRICT USE FRONT YARD SIDE YARD SIDE YARD REAR YARD NOTES SITE OR PLOT PLAN •For Applicant Use ON Plans must be filed and approved by the Inspector before a permit will be granted. No. V�:f, City of Salem n � Ward F w Home Phone # APPLICATION Bus. Phone # `)5// FOR PERMIT TO INSTALL A SOLID FUEL BURNING STOVE Salem, Mass., T04 / �. 93 TO THE INSPECTOR OF BUILDINGS: The undersigned hereby applies for a permit to b44ild according to the followiryrygq specifications: Owner's name and address gpl�e y LJS ft d f C. 2L ,2 /��S Cot�/t Y Architect's name SB S Mechanic's name and address !(-6 191+1 4469 5-r T¢F1-c&oP✓ )9(/Q- Location 1ALocation of building,No. &77-5 COV What is the purpose of building? Material of building? -- If If a dwelling,for how many families? Will the building conform to the requirements of the law? 4 Estimated cost ;4 tors 'c No. Signature of applicant -76z= S -2� REMARKS ,rr�r�t�ry�i� 9ce ©n1 Uct2< e. s� e m C �.isn/�t/ .Yt�gKii✓� 11A f 4' �az ,Para APPOCATI, FOR 4ry PERMIT TO INS -AL`L"& SOLID FUEL BURNING STOVE Hix w PERM17 GRANTED. •z p +7 3- APPT'OV-qd ,Ll Cfor# � r AA z � p r f Y FIELD COPY ~ ° CITY OF SALEM BUILDING ?' SALEM, MASSACHUSETTS 01970 PERMIT .� V.LID.TION 4C DATE .71T1y 77 19_993_ PERMIT NO. 276-93 APPLICANT William Lach ADDRESS 250 Jefferson 83e. Salem 508 _ IxO.1 (STR[[TI (COxT R•S SICf x![I PERMIT TO Al tPr flrwnl aF`P (�1 STORY ilmral lincT NUMBER OF ITTK 0• IURR OxEMCNT1 .O. IRROR SED USEI DWELLING UNITS I AT ILOCATIONI 2 Pitta Court Ward T ZONING DISTRICT R -2 (MOAT • ISTREETI - BETWEEN AND ICI1OS. STREETI (CROSS STR[ETI 1 .. LOT SUBDIVISION LOT BLOCK SIZE BUILDING S.TO BE FT. WIDE BT FT. LONG BY FT, IN HEIGHT AND SHALL CONFORM IN CONSTRUCTION TO TYPE USE GROUP BASEMENT WALLS OR FOUNDATION INF❑ REMARKS, Alter fireplace on reuerce side of chinmey/see thru unit -PEA on,OL UME I! C P �V ESTIMATED COST $ 2.000 FEEMIT 5. 20.00 '.c:R Ic"OUARf FEE .]WNER Stanley Uscvicz A^D.ESS 2 Botts Court Salem.Ma John T_ 7ennin$ INSPECTOR OF BUILDINGS INSPECTION RECORD OST( MOTS PROGRESS C11111C13Yf ♦NO 11Ew111111! 1"S►lCTOF BUILDING PERMIT' JOB WEATHEi4S!ly DATE itS�ffl fl'(�:} 1,9 �3 PE RMiT I�O. APPLICANT JC AD �8O7�C'£ ADDRESS 40 a ;rGbrt A. .Q PA. ii nuaIIIaa NUMBER OF INC.) ISTREETI - . . 'ICOMTR•S LICENSE, D 8B2u1S6A PERMIT TO (_) STORY DWELLING UNITS (TYPE OI iNIMPROVEMENTI NO. (PROPOSED USE) Y� AT (LOCATION) d loot& COuTc Word D ZONINGDISTRI IND-.1 .ISTREETI k. . BETWEEN Chestnut Be. .. -. AND I.kOG$ Sc ICROSN STREET; (CROSS STREETI _ LOT'. [ SUBDIVISION LOT BLOCK SIZE BUILDING IS TO BE FT. WIDE BY FT. LONG BY FT, IN HEIGHT AND SMALL CONFORM IN CONSTRUCTION TO TYPE USE GROUP - BASEMENT WALLS OR FOUNDATION ITIPE) QRCop:itzuc:R interior v/o*% bat4roomM , remedat a.€t.chou,ne.9l ntBtG M.{zirld REMARKS: _-- - - - - - Call for Permit to OccupyAREA OR qc VOLUME ESTIMATED COST $ VJQ{ZQ0 FEEMIT S, r.B63R0. 'C'JSIU SQUARE IEETI .Y ) •,Ifs OWNER JenainBa ,�I ADDRESS i 9LG 4 VE)31C ti -«, t.'%®3. - BYILo1N0}P@PT,u . . INSPECTOR OF B.I11LDINGSa THIS PERMIT CONVEYS NO RIGHT TO OCCUPY ANY STREET, ALLEY OR SIDEWALK OR ANY PART THEREOF. EITHER:TEMPORARILY OR PERMANENTLY. ENCROACHMENTS ON PUBLICA PROPERT r. NOT SPECT FIC AIIv PERM,TT EO UNDER THE RUILOING C.00E;IMUST-BE AP- PROVED BY THE.JURISDICTION. STREET OR ALLEY GRADES AS WELL AS DEPTM AND LOCATION OF PUBLIC SEWERS MA-VOE_OBTAINED FROM THE DEPARTMENT OF PUBLIC WORKS. THE ISSUANCE OF THIS PERMIT DOES NOT RELEASE THE APPLICANTFROMTHE-CONDITIQN5 OF ANY APPLICABLE SUBDIVISION RESTRICTIONS. k^^¢+x . , - MINIMUM OF THREE CALL APPROVED PLANS MUST BE RETAINED ON JOB AND THIS WHERE ARA 4BLESEPAR ATE „­INSPE ONSTR_REOUIRED K: -: CARD"KE'PT POST6D UNTIL FIN4LiN5 INSPECTION BEEN PERMITS aRE.-REO UICTIOMSRED_,•FOR ALL CONSTRUCTION WORK - ELECTRICAL, PLUMBING .AND - - - I. FOUNDATIONS OR FOOrINGS. . MADE. WHERE A CERTIFICATE OF OCCUPANCY IS RE. MECHANICAL INSTALLATIONS. 2. PRIOR TO COVERING STRUCTURAL QUIRED,S VCH BUILDING SMALL NOT BE OCCUPIED UNTIL ' ME MISERS I READY TO LATH). FINAL INSPECTION HAS BEEN MADE. S. FINAL INSPECTION BEFORE .1 OCCUPANCY. ' x - POST THIS CARD SO IT IS VISIBLE FROM STREET BUILDING INSPECTION APPROVALS 'LUMBING INSPECTION APPROVALS ELECTRICAL INSPECTION APPROVALS 2 � 2 2 F 0� �9 PIARO IF HEALTH GA!INSPECTIOIS!APPFIIJVAl FIRE DEPT. INSPECTING APPROVALS I 0' OTHER CITY ENGINEER 2 ,V \ WORK SHALL NOT PROCEED UNTIL THE PERMIT WILL BECOME NULL AND VOID IF CONSTRUCTION INSPECTIC41 "'1ICATED ON THIS CARD INSPE" JR HAS APPROVED THE VARIOUS WORK IS NOT STARTED WITHIN SIX MONTHS OF DATE THE CAN OF IRRA-CSD FOR BY TELEPHONE. STAGES OF CONSTRUCTION. OR WRI,-=.. NOTIFICATION. PERMIT IS ISSUED AS NOTED ABOVE. AKN y CERTIFICATE ISSUED p� CITY OF SALEM 99 DATE __MA, h 7 IOQL SALEM, MASSACHUSETTS 01970 BUILDING PERMIT — a4`OmT CERTIFICATE OF OCCUPANCY APPLICANT S t an Jsovica 04 TE A34689317 8 93 R R 345-93 MPJ J1 ♦GONE 55 O� �VLLZ �l�y Zemodol INP•' IST"", PERMIT To -Nary It.P[ Of IUT•Ir OV[M(NN (�-1 STORY Dwelling NUMBEROF 0 Iro0R0a[D ua[I OWEILING UNITS N ILOCSTIONI ., -oart IK0.1 frard ZONING ISTa([TI DIST 7,R BETWEEN Chestnut tit , I(K Oaa ST as ETI AND Essex f]t , SUED IV IS ION (CROSS STR[(TI LOT BLOCK LOT SIZE BUILDING IS TO BE FT, WIDE P• ' FT, LONG BYE FT. IN "EIGHT AND Sn4LL CONFORM IN CONSTRUCTION TO TYPE USE GPOUP '��---��BASE MEMT W1LL5 OR iOUNDaT,ON_ .REMARKS: Reconstruct inter for y7 /n@y7 bathrnnmEe7:=mOAeL kCe 1C !len eLna il• i1aC5 Wl r.l:'1 Lr AREA OR VOLUME IN"11-11 <'�BIC'SOLVa[ f[[TI awNERaDDRESS iu S.nnr� a � ' 'br erseYrernls •) Dl a i'------ Toesage -- SEE R(y'E[j j� BVO[ F�TEDR,ELfdISES Tme Y OF CERTIFSCATf- I I DEPARTMENTAL APPROVAL FOR CERTIFICATE �'. of OCCUPANCY and COMPLIANCE `-"To be filled in by each division indicated hereon upon completion of its final inspection. BUILDINGS Permit No. 345-Q3 Approved by T," F. Tremblay Date _ 3/7/94 Remarks — I; I PLUMBING Permit No. Approved by John T,eClerc Date -_3/7/94 Remarks ELECTRICAL Permit No. j` Approved by At Falkowski Date 3/7/Q4 Remarks f OTHER_ Permit No. Approved by_ Date Remarks it OTHER Permit No. Approved by Date Remarks fL*NS�Atl6TeEfiLeD4A9 APPROVED BY 1W ALRECILIB,PWR TO XPER111T,BgING GRANTkD N�� CITY OF SALEM S oaword zw"Owns the HWafo DWdd?„ YM No Loeatios o! 1 ._ aa�diae 0'� Is PIWOmY Loalad In 70 Canavabon Ann? YM No Permit to: BUILDING PEWIT APPLICATION FOR: (Clrcle whichever apply) GRoof, Retool, InaWl Siding, Construct Dock, Shed, Pool, PLEASE RLL-OUT LEGIBLY&COMPLETELY TO AVOID DELAYS N PROCESSING TO THE INSPECTOR OF BUILDINGS: '• The undersigned herby apples for a permit to build accordGig.to the following- Owners Name Address A Phone Z, CAS, nr+ c ID 744— iA z Architect's Name Address & Phone Mechanics Name Address 6 Phone ( 1 What Is Me p.pm at f.rldrlp? 2 b;d�', c1 maw of falYdrq? -- W"d M.dwaNrq,for how mw taman? % wN b A*Q amMonn to hw? Amb~ F.afanNlW am `�� r00 Cpy lkaw tt 8wa Lloarw M _ eo■. I�tvsarat -Signature of SIGNED UNDER TNEt PENAL OF PERJURY DESCRIPTION OF WORK TO BE DONE z E r MAIL PERMIT TO. y+ ' .t I APPLICATION FOR PTO LOCATION PERMIT GRANTED y�(IIV s 19 INSPECTOR OF 81JILDINGS. 9 crf y OF SALEM BUDZING DIPARTM 'lir liCUZ0 NMk ucENSE DmdrYlON Phase PAN DA A �ILOT 'HOMEow1� . . TELEMMM PPZSbff MAUZM ADDRns not emreas.oamptioo d-iwasowOUC wu wended to bchda owoer.�+vid.a.na�:a dTwo L)niu a ka and to aiiow sneh homeowmn to enpr as bedWldmii fer him who doe yet pones• ibcme,pewided ist the ewya act as wpavism DErDGTICNtFHCNEo tm penoo(5)wbc owra a pared of WW an whktt Le/shc asides a haerda to redd%as v4a* s�� . buarded to K s ene to two find p dw cgn&susdad a dttadard mocyne=cs_shs1 so �nsldned farm swocwm A pcnan who eonstrocv mat:tau cat home in s two• y�P to it sbmmgwM BwldbgOd><r>JSS aLcldebe>rsponnbk,can p yudatie6ui1�pvaL The mederApted-homwwacf astwra tapmaibf v fa=MPH==wbb*t State sco tK Cods:ad ether oppScabk Sots by4ovA,reka and njWadeot The tmdcmpad'Mmwwmp=ufxs tat Wft mdovaadt the CIW of Sak=Burm%g F R Wmao bt+ wdm pmesdme tad rega=wms and tat Abbe wig e oad"ad tagtdtmes< HOMEOWNER'S SIGNATURE Q APPROVAL OF B=D4G IIiSPECTOR See other side fa sate code • ii HOMEOWNER'S EXEMPTION The Cods states that •I h—owTer paformdn540it for adds bung puttdt-istegoi �s-M-- -- --- - ' exengx Leto the pev�irioas o[tbit sectto• (Secttoa 309.1.1-uansios d eoatttvetioa E•perrSsae�• . 1'ravided Chet is•bameowaa era�persaa(�)for ble to do.such troth that tatCb bomeowaer sbatf tat tag bomeosmmfs wbo use this a mmpko we inawats tba*cy an at come dw pqomdWMn eta rnpaybor Gw Appendls Q.Auks end Replatiow for 12ocosl•d Ceaar•etia•Supervb$M Sown L24 Tbb Let cf swarama ch n nsohs L senors poblcros. w lea the boraeosrM.bbad uanCwod person, In titb case yaw Bard Comm proceed ajabst to tautoemed papa n ltwould tdd ik eared Supenisa. 7bc bomeoaier salts as wpuvbw Y•b1mMe�eesjosbsslL To Comm tha tic hounotirrer b fail aware o[huna•tesponsibmda.ramp aomaao�dsa tegdra;sa prat of tba perndt sppnadm that On baaecow oadtlr tbat bLWw undasands the respoas>bDUs s do rupayboL You tog care to amend and adopt saib a ftrmlardAeadao In use In yaw coonsaudtp. , The Commonwealth of Massachusetts \ CI'fYOF � Board of Building Regulations and Standards SALEbI ]/ Massachusetts State Building Code, 730 CMR Revised:t/ur 2011 Building Permit Application To Construct, Repair, Renovate Or Demolish a One-or Two-Family Dwelling This Section For Official Use Only Building Permit Number: Dat Applied: Y/ S Jolt' Building ofticial(Print Name). Signatpra Data SECTION 1:SITE INFORMATION I.I Property Address:21 6V t-?�T— 1.2 Assessors Map& Parcel Numbers 1,la Is this an accepted street?yes noMap Number Panel Number 1.3 Zoning Information: _ 1.4 Property Dimensions: Lot Arcs(sy tl) Frontage(It) + 'Caning District Proposed Use j 1.5 Building Setbacks(ft) Front Yard Side Yams Rear Yard ReyuinJ Provided Required Provided Required Provided 1.6 Water Supply:(M.G.L c.40,§34) t.7 Flood Zone Information: 1.8 Sewage Disposal System: Zone: _ Outside Flood Zone? Municipal❑ On site disposal system ❑ Public❑ Private❑ Check if ye3Cl SECTION2: PROPERTY OWNERSHIP 2.� ncrt o Record: S'c� �� � 9 2vl , lMa 0/ >0 ' �Ynte(Print) City,State,ZIP -2 60 'f No. and Street Telephone Email Address SECTION 3: DESCRIPTION OF PROPOSED WORK'(cheek all that apply) New Construction❑ Existing Building❑ Owner-Occupied ❑ Repnirs(s) Alteration(s) ❑ r\ddition ❑ Demolition ❑ 1 Accessory Bldg.❑ Number of Units_ Other ❑ Specily: Brief Description of Proposed Work': Ir 1A PY 0tti!n7 Pt' I SECTION a: ESTIMATED CONSTRUCTION COSTS Estimated Costs: Official Use Only Item Labor and Materials) I. Building S 00 O 1. Building Permit Fee:S Indicate how ree is determined: ❑Standard City/Town Application Fee 2. Electrical S ❑Total Project Cost'(Item 6)x multiplier x 3. Plumbing •S 2. Other Fees: S 2( 4.,\lech;ulic:d (I-IVAC) S List: CCCC..JJJJ j. ;\(ech,mical (Fire S _ Total All Fees:S . Su ression) Check No._Check r\mounk Cash r\mount:_ 6, Total Project Cost: S ��r 000 ❑Paid in Full ❑Outstanding Balance Due: �� a SECTIONS: CONSTRUC'fIONSERVICES SConstruction Supervisor License(CSL) ��. r l ( a� Li cnse Number E.epurrutiun Date Name of CSL[[older yP ( ) List CSL'f a see below V V r P S� Type Description No. and Street and c� . . . Y n O/�r, U Unrestricted(Buildings u to 35,000 cu. It. Sa /1P/L1 r / l I It Restricted 1&2 Famil Dwelling City/l'omo,State,ZIP NI Masonry RC Roolin Covcrin WS Window and Siding p�7 SF Solid Fuel Burning Appliances -Y Insulation 'fde hone Email address D Demolition 5.2 t•gisteredHome mprov/ement Contra for(111C) /O 3 U& / 7 Zv P / r"//I ��(M �j�r ' ' M�� HIC RegisuationJNumber E•spirution Date HIC HIC Reis ant Name oC L7li/ o/o�P No. ;ut Street �� Email address Cit /'fuwn,State ZIP Telephone SECTION 6:WORKERS'COMPENSATION INSURANCE AFFIDAVIT(M.G.L.e.152.g 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 Issuance of the building permit. Signed Affidavit Attached? Yes .......... No...........❑ SECTION 7a:OWNER AUTHORIZATION TO BE COMPLETED WHEN. " OWNER'S AGENT OR CONTRACTOR APPLIES FOR BUIILDING/PERDIIT I,as Owner of the subject property,hereby authorize ahp/ /�I I Cif/1 a o CY t9 act on my behalf,in all matters relative to work authorized by this building permit application. Mary VsoLI Print Owncr's Y ;uue(Electronic Signatu Date SECTION 7b:OWNEW OR AUTHORIZED AGENT DECLARATION By entering my name below, 1 hereby attest under the pains and penalties of perjury that all of the information contained in this application is true and accur;3� st of my kno% edge and understanding. P � 1/� at� s a,-) ry . Prinl�s.kaah ur AutbocizeJ Agent's Nantn(Electronic Siguuutre) ate 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 lntprovement Contractor(FIIC) Program),will not have access to the arbitration program or guaranty fund under M.G.L.c. I42A.Other important information on the HIC Program can be found at www.mur's. •uv'uca Information on the Construction Supervisor License can be !bound at www•.mass.sov:'d.L ' 7. When substantial work is plumed, provide the information below: 'folal tloor area(sq. R.) (including garage, finished bascment/attics,decks or porch) Gross living area(sq. It.) Habitable room count Number of fireplaces Number of bedrooms Numbcr of bathrooms Number of half/baths I Mlle of heating System Number of decks/porches l'ypeof Cooling systell Enclosed Open 1. "fatal project Square Footage"may be substituted liar"fot:d Project Cost" �z.3 'tea imonivealth of Alassachusetts C� NL 1017 JAN 26 p Sheet Metal Permit Date: I I U 201-4- Permit t# Estimated Job Cost: S 5,ODU Permit Fee Ob n ! Plans Submitted: YES NO Plans Reviewed: YES NO t llslneSS License , J Z�Z 13 -- '7 16 Appcalnt License## li �kta i �4'aJNL"� Business intimnation: Property Owner/Job Location information: Nance: Divi Am NS'tf.NS, TA►C• Name: M41W ut.SOVSC,, Street: (9a fo¢tsT lz=oe; Dr, Street: a? Som C Lmf- City/Town: ROwt t f City/Town: S,4 trg Telephone: Telephone: - (918) 31-4-3y3y Photo I.D. required/Copy of Photo I.D. attached: YES NO - staff I nIII21 restricted license J-2/ M-2-restricted to dwellings 3-stories or less and commercial up to 10,000 sq. ft./2-stories or less Residential: 1-2 family )C Multi-family Condo/Townhouses Other Commercial: Office Retail Industrial Educational Institutional Other Square Footage: funder 10,000 sq. ft. )( over 10,000 sq, ft. Number of Stories: 3 Sheet metal work to he completed: New Work: Renovation: 11VAC Afetal Watershed Rooting Kitchen Exhaust System Metal Chimney i Vents Air Balancing Provide detailed description of work to be done: TNSTAI.t,4rT0M OT kAAJrLO I HfoH V60C-r `{ I CLN'tZt'kL AT(Z C0AjID `tr0.AJTNCr Sy ntit W AIL MOIANI'ED CoAJAen15PQ, SySS�M �S C[�nW�i 4_UN L-%-f (Na lP L CrK., P— CI INSURANCE COVERAGE: I have a current liability insurance policy or its equivalent which meets the requirements of M.G.L.Ch. 112 Yes No❑ + If you have checked Yes,indicate the type of coverage by checking the appropriate box below: A liability Insurance policy M Other type of Indemnity ❑ Bond ❑ i OWNER'S INSURANCE WAIVER: t am aware that the licensee does not have the insurance coverage required by Chapter 112 of the Massachusetts General Laws,and that my signature on this permit application waives this requirement. Check One Only r Owner ❑ Agent ❑ Signature of Owner or s Agent By checking this box[].I hereby certify that all of the details and Information I have submitted(or entered)regarding this application are true and accurate to the best of my knowledge and that all sheet metal work and Installations performed under the permit Issued for this application will be In compliance with all pertinent provision of the Massachusetts Building Code and Chapter 112 of the General taws. Duct inspection required prior to Insulation Installation: YES NO Proaress Inspections Date Comments Final Inspection [)ate Comments Type of License: j By ❑Master /1 r,de C]Master-Restricted u' _-.------ ❑Jaurneyperson Signature of Licensee Pennd� _ ❑Journeyperson-Restricted License Number: -- _ ❑ ' Check at ::.v:v mass.aov'r!L r f +� lnspet;tor Signature of Pena;t Approval {, �txt ti1101114'ealth of Massachusetts CZ 1811JAN 2b Sheet Metal Permit p �. �? Date: 1Iuv1i- Permit Intimated Job cost: S 15,aqo _ - --- Permit Fee: Plaits Submitted: Y l;SNO� ---___ r� Plans Reviewed: J'ES NO Business License# - Applicant License 0# �- 13usiness int-onnation: 6 kf:A1-'L: 1 . ISP-aJN�-�� Property Owner/Job Locatio+, hiformation: Nance: DRY Pav S,iS't ms ?nJC. Name: NI49-Y lalSoySC-j. Street: _(pa �o¢trST R , - Street: a? 13oM &tAtzr City/Town: Rom-Ey City/Town: fclephune: _ ( 1 gy$-alSl Telephone: 3y3y Photo I.D. required 1 Copy of Photo I.D. attached: YES ,NO restricted license Seautat J-2/,fit-2-restricted to dwellings 3-stories or less and commercial up to 10,000 sq. tt./?-stories or less Residential: 1-2 family-)(— Multi-family Condo/Townhouses Other Commercial: Office Retail industrial Educational Institutional Other Square Footage: under !0,000 sq. ft.� over 10,000 sq. ft. Number of Stories: 3 Sheet metal work to he completed: New Work: Renovation: IiVAC Metal Watershed Rooting Kitchen Exhaust System !%ictal ('Kinney/ Vents Air Balancing I'ruvide detailed description of work to be done: r_ NS7At-1 RTTOr`) O'f uA1S(p Nf&" vblocrT`( I CCAJMkL AT(L (-0AJD `rro�5'A)Cr MOIANtED CG-IAeNSf'R._5yST-M TS [L20L gni 4_UN L`( � � � 191 � � INSURANCE COVERAGE: 1 have a current liabili insurance policy or its equivalent which meets the requirements of M.G.L.Ch.112 Yes No El ifY ou have checked Yes, Indicate the type of coverage by checking the appropriate box below: Other type of indemnity C1 Bond C]A liability insurance policy �, yp licensee does not atnce his requiregmenetquired by Chapter 112 of the OWNER'S INSURANCE WAIVER:I am aware that the Massachusetts General Laws,and that my signature on this permit application waive 3 Check One Only Owner ❑ Agent E] Signature of Owner or s Agent I have submitted(or entered)regarding plication are true and ac checking to this box[].I herebycertifyd d thatthat iof the details and all sheet metal wok and installations performed under the permit issued forthis application wilt� accurate to the best all er knowledge In compliance with ail pertinent provision of the Massachusetts Building Cole and Chapter 112 of the General Laws. Duct inspection required prior to Insulation Installation: YES NO Prnuress 111SPectiO11S C0111me11tS Date Final Illsllrctioll Comments [)ate Type of License: MasterBy nue ❑Master-Restricted j ❑Journeyperson Signature of Licensee i Pernut x _ — ❑Journeyperson-Restricted License Number: Fee _ - ❑ ___---_ Check at•:;•v:v.Jt.i•�`_�"-'li�l I I Inspector Signature of permit Approval _. ..