26 ABBOTT ST - BPA-16-331 REMODEL KITCHEN ' VED
r The Commonwealth of Mas¢r7via tittA TRevlsed,tIar
ITY OF
n ,Board of Building Regulations and Standards SALEM
Massachusetts State Building 8 �u
g Co,'-`'- WL 1 P 20//
( Building Permit Application To Construct, Repair, Renovate Or Demolish a
n One-or Two-Family Dwelling
-Y This Section For Official Use Only
Building Permit Number: Date App e :
I Building Official(Print Name). Signature - Date
SECTION It SITE INFORMATION
1.1 Property Ad tress: 1.2 Assessors Map Sr Parcel Numbers
T2 G A , P S�
I.1 a Is this an accepted streetT yes no Map Number Parcel Number
1.3 'Zoning Information: 1.4 Property Dimensions:
Zoning District s: .Proposed Use LolArita(sytt) - Frontage(11) -
1.5 Building Setbacks(R)
Front Yard . . - Side Yards Rear Yard .:
Required Provided -Required Provided. Required Provided
1.6 Water Supply:(M.O.L c.40,§54) 1.7 Flood Zone Information: 1.8 Sewage Disposal System:
Public❑ Private❑. Zone: _ Outsideif Flood ZoneT Municipal O On site disposal system ❑
Cin:ck C9❑ :.
SECTION'2: PROPERTYOWNERSHIP!
q . gr 2.1 gwne 'of gec ?r-
l7ly "7 Oit-.o
N;nne(Print) City,State,ZIP
-
zG6( 9 b6
No.and Street Telephone Email Address
SECTION 3:DESCRIPTION OF PROPOSED WOW(check all that apply)
New Construction❑ Existmag Building❑ owner-Occupied ❑ I Repairs(s) KI Alteration(s) O Addition ❑
Demolition ❑ Accessory Bldg.❑ Number of Units_ Other ❑ Specify:
'Brief Description of Proposed 1Yor
SECTION 4: ESTIMATED CONSTRUCTION COSTS
Itcm Estimated Costs: - Official Use Only
Labor and Materials - - -
I. Building - S 10,aa� - 1: Building Permit Fee:$, Indicate how fee is determined:
❑Standard City/Town Application Fee
2.Electrical S SOU ❑Total Project Cost'(Item 6)x multiplier s
3. Plumbing S t rj UO 27 Qther Fees: S
4.Nicchanical (FIVAC) S List,
5.N fee hmticaI (Fire S 'total All Fees:S
Su ression)
Check No. Check Amount: Cash r\mount
6. Tott) Project Cost: S wo ❑Paid in Full 13 Outstanding Balance Due:
:•,vw,i i SEC,i ION5:,CONSTRUC [ON SERVICES
5.1 Construction Sup rvlsor License(CSL) C y 9 Z -.-2 -
��/� 5'' f t7 - t'ft t License Number Expiration Uale-
Name of CCS,L[folder List CSL'rype(see below)
Ty e' - - Description
No.:mJ Sues
/ n U Unrestricted(Buildingstip-to 35,000 cu. If.
p //,Q/ t(-j /r'�!t C�� 9�� R Restricted I&2 Family Dwelling
Cityfro�State,ZIP I1 Masonry
RC Roofing Covering
WS Windmv and Siding
S I Solid Fuel Burning Appliances
`6 y0 (�e) 1 1 Insulation
Telephone Email address D I Demolition
5.2Registered Home//Improvement Contractor(HIC) ( 4 H 6 ° 5 Y
11,1)(! HIC Registration Number Expiration Date
IIIC C(mR'.ury>amc uS HIC Registfrpt Name
No.and Street Email address
,A-,A- 0 ryi5
City/Town. State ZIP Telephone
SECTION 6:WORKERS'COMPENSATION INSURANCE AFFIDAVIT(M.G.L.e.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 Isivance of the building permit.
Signed Affidavit Attached? Yes ........11413 No...........O
SECTION 7a:OWNER AUTHORIZATION:TOBE.COMPLETED.WHEN
OWNER'S AGENT OR CONTRACTOR APPLIES FOR BUILDING.PEM11T'
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 Nano(Electronic Signature) Dale
SECTION 7b:OWNERI 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 wledge and understanding.
Print Owner's or Authorize Agent's Name(Electronic Signalpre Date
NOTES:
1. An Owner who obtains a building permit to do his/her own work,or an owner who hires an unregistered contractor
_knot registered in-the Home Improvement Contractor(HIC)Program),will no have access to the arbitration
program or guaranty fund under�LG.L.c. Id2A.Ot Other tmportanf info7lnnfiofi o"n-the HIC-Program can a faun a1' ---
www max,cov.'oca Information on the Construction Supervisor License can be found at wAw�ns
2. When substantial work is planned,provide the information below:
'rota) floor area(sq. ft.) 4 (including garage, finished basetnent/altics,decks or porch)
Gross living area(sq. If.) 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 ofcoolingsystem Enclosed Open
3. `Total Project Square Footage'may be substituted for"ToLd Project Cost"
150 i"
- — -95"-_..,_. ter. �,34'f
69
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All dimensions size designations ~— This is an original design and must m Designed: 3
given are subject to verification on not �elessed.Ur_cc�n' '+mot