3 ALBA AVE - BPA-08-1021 POOL & FENCING The Commonwealth of Massachusetts
t Board of Building Regulations and Standards Pt)N
�. ' � Massachusetts State Building Code. 780 CMR, 71"edition Ml'NI(IIP �l.l"I 1'
\\ �t ,, ti,
V Building Permit Application To Construct. Repair. Renovate Or Demolish a Rrrr,rJl:ur,r:ut
One- or Two-Fumih Dwelling 1. 'rx/y
This Section For Official Use Only
Building Permit Number Date Applied:
Signature:
\ Building Commissioner/ Inspector ul Buildings Date
SECTION I: SITE INFORMATION
1.2 Assessors Map & Parcel :Numbers
/-�—
I.la Is this an accepted street?yes nu 'dap Number Parcel Number
1.3 Zoning Information: 1.4 Property Dimensions:
Zoning District Proposed Use Lot Area(sq tl) Frontage UU
1.5 Building Setbacks (h)
Front Yard Side Yards Reis Yard
Required Provided Required Provided Required Provided
1.6 Water Supply: (M.G.L c. 40, §54) 1.7 Flood Zone Information: 1.8 Sewage Disposal System:
Zone: Outside Flood Zone? Municipal ❑ On site disposal s s(cm ❑
Public❑ Private❑ Check if es❑ P �' Y
SECTION 2: PROPERTY OWNERSHIP'
2.1 wnerl f Recur
-v Pi),hne�
Na (Print) I Address for Service:
-05
Signature Telephone
SECTION 3: DES R PTION OF PROPOSED WORK(check all that apply)
New Construction ❑ Existing Building❑ Owner-Occupied ❑ I Repairs(s) ❑ 1 Alteration(s) ❑ Addition ❑
Demolition ❑ Accessory Bldg. ❑ Number of Units_ I Other ❑ Specify:
Brief Description of Proposed Work': L NST/3-/( ate^ G/OUi(tJ �BG �ry//J
�ENGf.t/Ci
SECTION 4: ESTIMATED CONSTRUCTION COSTS
Item Estimated Costs: Offlclal Use Only
(LaM)r and Materials)
I. Building $ I. Building Permit Fee: E Indicate how fee is determined:
❑ Standard City/1•own Application Fee
2. Electrical $ ❑Total Project Cost(Item 6) x multiplier x
3. Plumbing $ 2. Other Fees: S
4. Mechanical (HVAC) $ List:
5. Mechanical (Fire b
Su ression) Total All Fees: S
Check No. Check Amount: Cash Amount
6. Total Project Cost: S 0 Paid in Full 0 Outstanding Balance Due:
SECTIONS: CONSTRUCTIsN SERVICES
S.l Licensed Construction Supervisor(CSL)
"R,
F..piruuun Datr
Name of CSL- Huller luw)JJressiu tu }S,WOCu. Ft.i
dk'_ Funul Dsselho
Signature N Niasonry Only
RC Rnidenual Rooting Cusenn
rclephune \VS Residential Windu(s .md 5idto
SF Rreidrnoil Solid Furl Bumme .\i illjmr loMJIIJn Un
D Residential Deuuthuun
5.2 Registered home Improvement Contractor(HIC)
HIC Company Nairtc or HIC Registrant Name Registration Number
Address
Enp(ratiun Date
Signature Telephone
SECTION 6: WORKERS' COMPENSATION INSURANCE AFFIDAVIT(M.G.L. c. 152. 9 2506))
Workers Compensation Insurance affidavit must be completed and submitted with this application. Failure ht pn(side
this affidavit will result in the denial of the issuance of the building permit.
Signed Affidavit Attached? Yes .......... D No ........... ❑
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 of Owner Date
SECTION 7b: OWNER' OR AUTHORIZED AGENT DECLARATION
1 , as Owner or Authorized Agent hereby declare
that the statements and information on the foregoing application are true and accurate, to the best of my knowledge and
behalf.
I
Print Name
L3.
ignature of Owner or Authorized Agent Date
(Signed under the pains and nalties of gu )
NOTES:
. 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 not have access to the arbitration
program or guaranty fund under M.G.L. c. I42A. Other important information on the HIC Program and
Construction Supervisor Licensing (CSL)can be found in 780 CMR Regulations I IO.R6 and I IO.RS, respectiNely.
Ebb
substantial work is planned, provide the information below:
rs area (Sq. Ft.) (including garage, finished base menUattics. decks or porch)
g area (Sq. Ft.) Habitable r(x)m count
fireplaces Number of bedrooms j
f hathr(x)ms Number of half/baths j
ating system Number of decks/ porches
oling system Enclosed Open
'-Total Project Square Footage— may be substituted for "Total Project Cost"
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Professional Land Surveyors & Civil Engineers
ESSEX SURVEY SERVICE 1958 - 1986
OSBORN PALMER 1911 - 1970
BRADFORD 8 WEED 1885 - 1972
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BERENCE: BR PG Christo R. o PIS
104 LOWELL STREET
PEABODY.MASS.01960
(978)531-8121
FAX:(978)531-SM 1L Il