0008 1/2 ALLEN ST - BPA-13-77 SHINGLES CL� I S"
-7 G,
I'lie C'onlnlumveallh of Massachusetts
i`1J y hoard of iuilding Regulations and Standards Cl IN OF
Massachusetts State nuoding Code, 7SO CNIR SALEM
Iuilding Permit Application 'fo Construct. Repair, Renovate Or Demolish u
Una• or r1tw4li urll• DwelI
This Section For 011i ' Use Onl
Building Permit Number: Da Applied:
Building 0I116al(print Mune) Signature Uatc
SECTION I:SITE INFORAI TIO
1.1 Pro rty Address: 1.2 Assessors la Parcel Numbers
I.la Is this an Luce led street? '« no Map Nunther v III Number
I.J Zoning Information: 1.4 Property Dlmenslons:
Zoning District Propnsad Its* Lot Area(sq II) Frontage(I1)
1.5 Building Setbacks(R)
Front Yard Side Yunls Rear Yard
Required Provided Required Provided Requirud provided
1.6 Water Supply:IM.G.1.e.40.§54) 1.7 Flood Zone Informatlonr 1.8 Sewng*Disposal System:
MIMIC❑ Private❑ Zon*: _ Outside Flood-Lune?
Chock il' a0 Municipal❑ On sit*disposal s)itern ❑
SECTION 2. PROPERTV OWNERSHIP'
2. wrier'of cord:
Nana1110 �Sa %� c�1976
u. in Street'
fe ep Email Address
SECTION J: DESCRIPTION OF PROPOSED WORKS(check all that apply)
New Construction❑ E.ristiny Building❑ Osvner•I I:I: I ed ❑ RI :I1 11(s) ❑ Alleratlanls) ❑ Addition O
Dnnolition O Accessory Bldg.❑ weber of Units_ Other O Spcciry:
Brief Description of Proposed Work':
Y2QlriLP. Ctoll'ar S /
r
SECTION J: ESTIMATED CONSTRUCTION COSTS
(lent Estimated Costs:
II.aburand.\I:uerials) OM NI Use Only
1. Building S I. Building Permit fee: S Indicate how Ice is determined:
2. Glcclrical S ❑Standard City.?wan Application Fee
❑Total Project Cost'I 1 Item 6).1 multiplier S . _- .-
_. Other Fees: S_
J, \Icchanical ill\
S \Icch.tmI:A hire '- -_ -- -------- - -_ . . .
1;u p rc»ion) S rotal .\II Fccs: S
o Total Project Cusl: i ('hecA No. Chock Amount: _ C',uh \nnnun:
❑ Rid in Full 0 outstanding Il.11.mce Due:
'�I M.C- i OW Imo,
sj.'C l IONS! ('ON5I'RU(`noN SF.RN'ICFS
S.1 ('onstructimt Sullen isor Liccuse I('St.)
I icen,c Nunlher I \pireliau
N.uneolCSl. ih+ldcr ....._ Ir\tC51. I)pelseehcut\1.._.__..__--.._
PC
No, Description
No, AilJ Slrect _ -_—_-- _-- (I I lnreslrideJ l lluBJiu s li 10 14,11110 a1. ILI
It Ratrict¢J iR? remit Dnclin
Cil)i faun,Shle.LIP
R(' Htn,lin Co\arin
K'S window .0d Sidin
SF SuliJ Fuel Ih,miII \Ppliwtecs
I Insulation
1'ele bona
14noi1 aJJre+a D 17cmolitian
5,2 Registered llume Improvement Cunlntctor(HIC)
IIIC Itegisl c\pintlion Dole
I IIC Contpan) Name or I IIC'Reyiwrant Noma
I:Inal1 aJJresa
Nu. wJ Sucet
Ci frown.State ZIP role hung
SECTION 61 WORKERS'COMPENSATION INSURANCE AFFIDAVIT(M.G.L e. 1l3.Failure
23o provide
Workers Compensation Insurance affidavit must be completed and submitted with this application. ure t to provide
this aflldavit 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.
Data
Print U\\ncr's Nwna(Elcdrunic Signaturc)
SECTION 7b:OWNERt OR AUTHORIZED AGENT DECLARATION
By entering my name below, I hereby attest under the pains and penalties of perjury that all of the informatiun
contained 'a this application is true and accurate to the best of my knowledge and understanding.
a
Date
Printl I '+ur: orircJ.\dent'+NumollSl¢euunicSignawrcl
VOTES:
\\ner\\ho obtains a builJing permit to do his.her own work,or an owner,who hires anrothe arbitrditionumctur
1. .\n 0 HIC) Pro raml.will nu have access
I nul registered in the Horne Inlproventeot Contractor1 important information on the HIC Program can be found at
Other
ram or uaranty fiat)and r M.G.L. . 142.k. viat+t
grog 6
,,,\,\ ,I ,h., �„ .•, I Information on the Cunsuu\:uon Supervisor Ll�ense can be fours
•, \\'hen substantial\vurk is pl;mncJ,pro\iJe the inl'ullinv'ion IuJilbclo'f, e, finished basement attics.Jacks ur porch)
rota) flour aria 1>4. 11.1 . ---
Bross I,\ing area 14 ll.l ._
Habitable room count
. .-.. \lllllhef Ul bCJfltUllti .. .. .
\umberoftircl,lacci .. —_ \untbcr tit'halfh;uhs
\unlherofhathraonls _ . . \unlberol'Jaki, parches '..
i
I\pe of lwating $)+lent Ihlea\eJ ..tillers
I'\pa at COPllllg t\ilellt
I ) ..I oial IIto i el St I ll lire I'„a L µi Ill a\ l+e HIbd11111CJ fUf I tll.11 Prujeet('a,l"
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