21 ABBOTT ST - BPA-12-806 INSULATION 1
I'hc C'onununsce;dth of Massachusclts CI I'), OF
Board elf Building Regulations and Standards
JJJ I'vfassachusctts State Building Code, 73q C'fvlR SALEM
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Building Permit Application To Construct, Repair. Renovate Or Demolish
Ooe-or Tuv-Fanlill Du eRin,\r
This Section For 011icia Use only
DuilJing Permit Number: Dat .\pplied:
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lluilJiny Olticial(Prim Nwnc) Signature Uatc
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SECTION I:SITE INFORMATION
1.1 :a rty Rf�Addr Nap ess: 1.2 Assessuri S Parcel Number
t30t-f c;
I.In Is.this an acce ted street?yes no Map Numher Parcel Numhcr
1.3 Zoning lnformatlon: 1.4 Property Dimensions:
Zoning District !Imposed(Ne Lot Area(sq 11) Frontage(11)
1.5 BuIldIng Setbacks(It)
Front Yard Side Yards Rear Yard
Required Provided Required Provided Required Provided
1.6 Water Supply:(M.G.1.c.40.§54) 1.7 Flood Zone Informatlia 1.8 Sewage Disposal System:
Public O Private❑ Zone: _ Outside Flood Zona? Municipal O On site disposal s)stem I
Check il' esO
2.1
SECTION2. PROPERTY OWNERSHIP'
nerr of Re oral:
oce I ovlR`f SAI -(N Ina o ,9 76
N;unu(I'rinU City.Stale,ZIP
2i esftott ST 97k-?l(t- 7 ) *4'
No.;aid Steel relephone Finail Address
SECTION J: DESCRIPTION OF PROPOSED WORKS(check all that apply)
New Construction❑ Existing Building❑ I Owner-Occupied ❑ Repairs(s) C3 I Alteration(s) O Addition O
Denwlition O Accessory Bldg. O Number of Units_ I Other pccity: _
Brief Description of Proposed Work-: G c s/
SECTION 4: ESTIMATED CONSTRUCTION COSTS
Item Estimated Costs: Ofliclul Use Only
(Labor;rod.\laterials) y
I. DuilJing S 1. Building Permit Fee: S Indicate how fee is determined:
2. Electrical S O Standard City?otsn Application Fee
❑Total Project Cust'(Item 6)x multiplier _..-- x
i 1. 1'hunhiity S 1 Other Fees: S_ --- -
J. \Ixhanical ill\.\('1 i List:
i. Mechanical tfire S .— ---- -__ -- .-
'su,ttcisiunl rot al All Fees: S
('heck No. C11"k Amnntnt Cush \nloune
I, Total Project Cnsl: i 3 ,,rr�� - — --
3 ♦V ❑ Paid in Full 0Outstanding Ilal:utce Due:
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SECPIONS: CONSI'MICTIONSF.RVICES
S.I C'onstructiun Su tars isar Licensr(C'SLI
r>�.�. dlfe� I icvnx Nunlhvr vp ;uion D:uv
V;It Ile(I .\Lll,�ldcr liit(:sl. l)pv(wv116m)-
No. jvd Succl
U 141reiuiacJ lBuilJins,; d, 7S,lllltl vu. ll.)
�i�� t._ ?'!/1_���U --.. . . Nv.uivrvJ Ih? Pamil D„vllin
0, lba n, Slate. IP Sl \lasuu
NC Rlwlin C'ovcrin
_ NAP µ'indu,r;mJ 3idin
SF Soli g s
Fuel Ilurnin Appliance
I Insulation
clv bony fmuiladdress O I Demolition
5.2�Reegistered llume Improvement Contractor(HIC) 3 (p /
IIIC Re ibiralion Nwntwr E, tind In ate
IIC Cum an en I It., IL .v1un Naneve� �Nu. wIJ 'UeM Email address
•n
Ci i own, State,ZIPfvly hone
SECTION 6: WORKERS'COMPENSATION INSURANCE AFFIDAVIT(M.G.L c. 153.1 25C(6))
Workers Compensation Insurance affidavit must be comp let bmitted with this application. Failure to provide
this affidavit will result in the denial of the Issuance a building permit.
Signed Affidavit Attached? Yes .......... No...........O
SECTION 7s. OWNER AUTHORIZATION TO BE COMPLETED WHEN
OWNER'S AGENT OR CONTRACTOR APPLIES FOR BUILDING PERMIT
I,as Owner of the subject property,hereby authorize HU-e
to act on my behalf,i matters relative to work authorized by this building permit application.
/2
Print Own. 's Nunic(BUx4forlic Sianatttg
Date
SECTION 7b-OWNERr OR AUTHORIZED AGENT DECLARATION
By entering my name below. I hereby attest under the ains and penalties of perjury that all of the information
contained in this application is true and curet best of my knowledge and understanding,
2,
Print Oi •r' or:\udulnry gent's Nanto runic Signawrol Duty
NoTES:
I. An Owner who obtains a building permit to do his.her own work,or an owner who hires an unregistered contractor
1 nal registered in the Hume Improvement Contractor I HIC) Program).will nu have access to the arbitration
program or guaranty fund under\I.G.L. c. 1 4_'.A. Other important information an the HIC Program can be found at
,,,,,t .',.I Information on the Construction Supervisor License can be found at
_' µhen substantial work is planned, provide the inl'unnation below:
total flour area 1 sy. fl.l - __—_.._I including garage. finished basement attics,Jocks ur porclu
(iraii living area I iy. IT.1 _-._ _ _ Habitable room count
\umber oflircplaccs .-. Numberofhvdruoms
Number of hathromns - . - _ . -- \unlher of b;Jf haths
I\pv of hvuting i)itelli Ntunhcr ol'Jecks, parches
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I\pv,�1 AoUhllg is ildlll I�IICIPivIJ ( elf
1, "I LII I'rajevl $yllafe f aal.lge"Illlll he +uhititutcd tier' I'owl I'rojvvt Coif' I