2 ADAMS ST - BPA-13-221 2 WINDOWS & 1 LALLY COLUMN / I� _ 7 --- I'he C'onunun.veahh of�bhusachusens - -
0 1� Board of Building Regulatums ;old Standards Cfl'1'OF
"ilssachusetls State Building Cude, 780 C NIR SALEM
Building Permit Applicillioll To C-unstruct. Repair, ilenuvate Or Demolish u
One- Or row.,"lrnnll•Di ellinp
This Section Fur Of lei Lisa Ool
Building Permit Number Dat Applied:
"",ding 0117nal(Prinl Nwne) Sitptulurc /
Dal
SECTION I: SITE INFOR31AT10
I,.I P orgy Address:rrts ST 1.2 Assessurs Alap arcel mbers
Adlat
I.la Is this an acre led street? •a no Map Numher I'urcel Namher
1.3 Zoning Information: 1.4 Property Dim one,
Coning Dislrics I'ropaseJ ll--wi Lm Anu(s 111 4 Frontage l 111
1.3 Bu1lJing Setbacks(R)
Front Yurd Side Yunls
Rear Yard
Required Front
RequiredProvidedRCslUlfrd ProVidld
1.6 Water Supply:IM.G.I.c.40. § !a) 1.7 Flood Zone Information: LS Sewage Disposal System:
Pablle❑ Privute❑ Zone: _ Outside Flood Zone?
Cheek If cs❑ Munieipd O On siro dlsposul s)stlm O
SECTION2. PROPERTY OWN IPs
2.1 0 r of Record:
N,unulPnnq � K'9 d(
('il)•,Slaw,Z
1/�
9'
Ad.�r+>S ST 7S'7 f� 35'�q
u.and Strcrl rule hone
p Emuil Address
SECTION!: DE SCRIPTION OF PROPOSED WORK'(check all that apply)
New Construction❑ Existing Building❑ Osvner-Occupied ❑ Repaln(s) ❑ Alteration(s) ❑ Addition O
Dem lilion ❑ accessory Bldg.❑ or or Units
Briel Description of Proposed Work-: Other ❑ .Speedy:
to H7 tr i o
SECTION J: ESTIJIATE0 CONSTRUCTION C05TS
ltcill Estimated Costs:
Il.abur and.Materials) Official Use Only
V Building S I. Building Permit Fee: S Indicate how fae is determined:
2. Vlacirical S O Standard Ciry.Tussn Application Fee
I I 111unihing S ❑Tuml Project Cost'(Item 6)a multiplier _ -- x
.. Other Fees; S
i J. \lei h,miial ill\ \('t S List
�u�lressianlS rot;d .\IlFces: S_
11 rulul Project Cn.t S t'hV'k No, _ -_Chcd t',nh \nnnml:
SdQ a v ❑Riid in Full ❑:)..:.landing Ihtl.mce Due
St.'('HON 5: CONSI'MI "PION SFKN"( F.'S
PC
nstriocd I fluddialts up W 'it
1(c,irwIN IN.'1.1111.1 Ihsellin
lam-11
State. K,%flin 01%crin
window A'S window.old Sidin
SF Sulid fuel Burning APPII�djllcl
I Insulation
yjl Adml-4 D
Demolition
l'ek• bane
91 ntro,2 Registered Ilonjit Intlirtivilnelit coclor(IIIQ ———— It 159
111C 14k:6111rallon N111"hur
I IIC C,1,jjpjjj) N,11neor IIIC 1(4ji.41runt
Nu.wid Street
Cit Ifirown,Sallai-e ZIP rcle hung 152. 2SC(6))
SECTION 61 WORKERS'COMPENSATION INSURANCE A IF F1 DAV IT(M.G.L c
a application. Failure to Provide
d submitted�wilhthis'a���
Work Compensation Insurance affidavit must be completed and submitted w
this affidavit will result in the denial of the issuance of the building Permit-
yes .......... NO.........
Signed A Mdavit Attached?
SECTIOF": O�VNERAUTH
UR'IZPATION TO BE COMPLETED WHE
�
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.
---- Data
Nwiie(ENctru"IcSillnuture) --------
r1_n71t_U nQr ------
------- AUTHORIZED AGENT DECLARATION
SECTION 7b: OWNER'OR AUT
entering my name below, I hereby attest under the pains and penalties of perjury that all of the information
By en is true and accurate to the best of my knowledge and understanding.
contained in this application —lev- /2
4 r_� C 0
1-0
Print t;)NAwri or
NoTESi registered
----
n ner%vhavoe a t hircitan u
i_11d Ttodo his her o%vn%%urk.or 1
b I a I I 15 a u 1 actor IHIC) Program).Will Ua� access to the arbitration
stractur
I Aut registered ino the Home I ItIprovpollent Conti other iinponant inrurniall-an on the HIC Program can be found a,
Program or guarmity 11und under.M.G.L.C. 141A .111,
ction stipenisor License can be found ti'41`
Onformatiunun theConstru
Is planned, pros 9 It t 111 rurmatiun below:2. hen substantial ki,ork including garage, I"Inis,jed basement attics. d%:%;Iks or porch I
rota) tiklurarca 114. tit I Habitable rouin count
Grois It%ilig area 114. tI.I
\11111tivr of 11;111 h.11114
hi:j,"I hathrouilli Nj,1jjhV(ol'Jecki. parches
\k1111 I JIQ of 1W.16114 (Ten
1`11do'cJ I
I peol coohitq he ,IIh,111lIIeJjkq ,rotal llroj",Ckilt"
�,Jit.trc I ootAk!Q III,"