4 ABERDEEN ST - BPA-15-802 INSULATION The Commonwealth of Massachusetts
Board of Building Regulations and Standards ' RECE FOR .
f�NICIPAL]71 Y
Massachusetts State Building Code,'780 CMR INSPECTION I SERME$
Building Permit Application To Coristract,Repair,Renovate Or Demolish a RevlsedMar2011
One-or Two Fmnily Dwelling 41 S AUG —b
Q This Section For Offici Only
Building PermitNumber. I Date plied:
t Buildin Official �ia l.,f )3 /
(� g (Print -. .. . Y t Signature Date
-- SECTION 1:SITE INFORMATION
t 1.1 Pro 1.2 Assessors Map&Parcel Numbers i`'�erzlt°e�✓ S+ �
1.1aIs this an accepted streWyes_ no` .t Map Number Parcel Number .
13 Zoning Information: . 1A Property Dim'enstoas'
ZoningDistdct Propose se Lot Area(sgR) . . . - Frontage(ft)
1.5 Building Setbacks(ft)
� . FtontYard - Side Yards gear Yard
Reqrdred ' Provided -` Requited ... Provided Required Provided
1.6 Water Supply:(ALO.L o.40,§54). 1.7 Flood Zone information: I.8 Sewage Disposal Systepp:
Public❑ Private❑ .. - zone: — Checkif es❑ e? Municipal❑ On n site disposal system ❑
_ Y
w� e�F SECTION 2: PROPERTY OWNERSHI/P'�
2.1O zC n; e HKSf1r✓
Name(print) lily,State,ZIP
U A6erAP.� L?7g-RV-O5S3
No.and Street . Telephone Rmaa Address
SECTION 3:DESCRIPTION OF PROPOSED WORW(check all that apply)
New Construction p Existing Building❑ Owner-Occupied ❑ Repairs(s) ❑ tation(s) ❑ 1 Addition ❑
Demolition ❑ Accessory" Bldg.❑ Numb rofUnits- 1 1 Other Specify
BriefDescriptionofPmp edWork�-
riD L
SECTION 4:ESTIMATED CONSTRUCTION COSTS n
Item l ct;.namt Costs:... ,
a6or and Materials !i Official Use Only
1.Building _ $ 1. Building PennitFee:$ - Indicate how fee is determined:-
2.Electrical $ ❑Standard Cityflown Application Fee "
17 Total Project Cost'(Item 6)x multiplier x
3.Plumbing $ " 2. Other Fees: $ �' 1
4.Mechanical (WAC) .$ List .S
5.Meebanicai (Fire
Supression) $— Total All Fees:$
Check No.IIACO Check Amount .. Cash Amount
6.Total Project Cost $ '{s(fU ❑Paid in Full O Outstanding Balance Due.
SECTION 53 CONSTRUCTION SERVICES
51 Construction Supervisor License(CSL) 7 q7-7
LicemeNumber ExiihatimDate
Name of CSL Holder
T Eric W.Palm ype
List CSL Type(see belnw)� -
No.and street 3 Hutton Street � Description
- I U Unrestricted(Buildings up to 35,000
Salem M'-A 01970 ` R Restricted lMFandl Dwel in .
city/Town,State,ZIP M Masonly .. -
RC Roping;Covering
WS Window and Siding
SF _ SolidFoelBumingAPpliances
'i I lnadation
Telephone Emaa address D - Demolition
5.2 Registered Home Improvement Contractor(HIC) ! �O 3 Z (p
Atlantic Weatiienuttiviy i ... HICRe&ftatron amber ExpuationDate
HIC company Nam orHl Ventre
Salem.MA 019,
No,and Sired - . Email address
atyJTnyn,Statq,2P T�hone
SECTION 6:WORICM,COMPENSATION INSURANCE AFFIDAVIT(MG L c.152.§25C(6))
Workers Compensation Insurance affidavit must be completed and submitted with this application. Failure to provide
this affidevitwcli result in the denial ofthelsnuance ebuildingpemrit
Signed AffidavitAttached? Yes.......... N07......._.O
SECTION 7a:OVMRAUTHORiZATION TO BE COMPLETED WHEN
OWNER'S AGENT OR CONTRACTOR APPLIES FOR BUILDING PERMIT
I,as owner ofthe subject properly,hereby autlrorizet
to act on my behalf,in all matters relative to work authorized by this building permit application
Pont s Name�(F.1 aSi Signature) .. Date
SECTION 7b9 OWNEW OR AUTHORIZED AGENT]DECLARATION
i
By entering-my-name below,I hereby attest under the pains and penalties of perjury that all ofthe information'
' contained in appEis at;to the best of my knowledge and understanding.V t
.�L�
I
Print Own(r's orAvdiorized Agen['s Name(Electronic Signature) - - Data
:J 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 Improvement Contractor(FUC)Progman,will not have access to the arbitration
program or guaranty find underM.GL.c.142A.Other important information on the HIC Program can be found at
www.mass. o�v/acahiformationontheCoustructionSupeivisorLieensecanbefouadatwww,mass.eov/dus
2. When substantial work is planned,provide the information below:
Total floor area(sq.tk) (including garage,finished basementfattics,decks or porch)
Gross living area(sq.it.) Habitable room oouat
Number of fireplaces Number of bedrooms
Numberofbathrooms Number-ofludiffbaths -
Type ofheatmg system Number of de"porches
Type of cooling system Enclosed Open _
3. "Total Project Square Footage"may be substituted for-total Project Cost"-