2 ABERDEEN ST - BPA-12-445 ROOF The Commonwealth of Massachusetts
� CITY
Board of Building Regulations and Standards
u, OF SALEM
Massachusetts Slate But in de, 780 CMR, 7 editio Revised January
Building Permit Application To C struct, ir, Renov r Demolish a 1. 2008
Irl One-or Ti o-Fum'y w !li g
o/ This S ion or 0 al a Only
Building Permit Number: Da pplied:
Signature:
Building Commissioner/Inspector uildingsk Date
SECTION 1:SITE INFORMATION
1.1 Property Address: 1.2 Assessors Map& Parcel Numbers
-r—
I.la 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 11) Frontage(tl)
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: I.S Sewage Disposal System:
Zone: _ Outside Flood Zone? Municipal❑ On site disposal system ❑
Public❑ Private O Check if esO p P� y
SECTION 2: PROPERTY OWNERSHIP'
2.1 Owner of Record: .,
lR r It a/Ln l�r�•+, b�[� —1 i i b a l� ST
Name(Print) T dress lbr Service:
-145 u9 \15�
Signature Telephone
SECTION 3: DESCRIPTION OF PROPOSED WORK'(check all that apply)
New Construction❑ Existing Buildin Owner-Occupie4::q Repairs(s Alterations) ❑ Addition ❑
Demolition ❑ 1 Accessory Bldg.❑ I Number of Units_ Other ❑ Specify:
Brief Description of Proposed Work': 'R o,V-7 d— R2 . VLoo
SECTION 4: ESTIMATED CONSTRUCTION COSTS
Item Estimated Costs: Official Use Only
Labor and Materials
I. Building S oD oa 1. Building Permit Fee:S Indicate how tee is determined:
❑Standard Cityllbwn Application Fee
2.Electrical S ❑Total Project Costs(Item 6)x multiplier x
3. Plumbing S 2. Other Fees: S
4. Mechanical (HVAC) S List:
5. Mechanical (Fire S Total All Fees:S
Su ression
Check No._Check Amount: Cash Amount:_
6. Total Project Cost: S ,j 3O�J 13 Paid in Full 0 Outstanding Balance Due:
SECTION 5: CONSTRUCTION SERVICES
5.1 Licensed Construction Supervisor(CSL) (1 (4, t,:— c4_
'T' Z)C>lobt;.S License Number Expiration Date
Name ol'C'SL•Ifolder
wT'" S< �,A 6o 9\.0 I.is1 C'SL'fype(ste below)
.4JJ ss 1`1 De Description
U Unrestricted(up to 35,000 Cu.Ft.
R Restricted 1&2 Family Dwelling
Signature M Masonry Only
21--) 8 S -�' I $ a 3 RC Residential Rouling Covering
fclephone WS Residential Window and Siding
SF Residential Solid Fuel Burning Appliance Installation
D Residential Demolition
5.2 Regblered Hg a Improvement Contractor(HIC) j Q n R l l
I IIC Company Name or f IIC Registrant Name Registration Number
2 W 6oeY
rj 25 X 8;334 Expiration Date
Signature Telephone
SECTION 6: WORKERS'COMPENSATION INSURANCE AFFIDAVIT(M.G.L.c. 152.1 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...........O
SECTION 7a:OWNER AUTHORIZATION TO BE COMPLETED WHEN
OWNER'S AGENT OR CONTRACTOR APPLIES FOR BUILDING PERMIT
1, , as Owner of the subject property hereby
authorize to act on my behalf,in all matters
relative to work authorized by this building permit application.
Signature ol'Owner Date
1 SECTION 7b: OWNER'OR AUTHORIZED AGENT DECLARATION
1, a—,,..y.✓ (—� t In. :a 1_l' (1,o—�= ,as Owner or uth d A en hereby declare
that the statements and information on the foregoing application are true and accurate,to the best of my knowledge and
behalf.
Print Name
%D- Zo-kk
Signaturc of Owner o ut onz ent Date
Signed under the ains and nalties o 'u
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&I have access to the arbitration
program or guaranty fund under M.G.L.c. 142A.Other important information on the HIC Program and
Construction Supervisor Licensing(CSL)can be found in 780 CMR Regulations 110.116 and I IO.RS,respectively.
L When substantial work is provide rovide the information below:
P
Total floors 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"may be substituted for"Total Project Cost"
J