5 AMANDA WAY - BPA-11-862 DECK The Commonwealth of Massachusetts
Board of Building Regulations and Standards CITY OF
I Massachusetts State Building Code, 780 CMR SALEM
Revised Mar 2011
r Building Permit Application To Construct, Repair, Renovate Or Demolish a
One-or Two-Family Dwelling
y This Section For 00kripl Use Only
a Building Permit Number: Dat pplied: r
41- - " l c c
Building Official(Print Name)° Signature Date
SECTION 1: SITE INFORMATION
Lj,Pro erty : 1.2 Assessors Map& Parcel Numbers
1.l a Is this an accepted street?y s no Map Number Parcel Number
1.3 Zoning Information: 1.4 Property Dimensions:
Zoning District Proposed Use Got Area(sq 11) Frontage(11)
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: 1.8 Sewage Disposal System:
Public❑ Private❑ Zone: _ Outside Flood Zone?Check if yes❑ Municipal ❑ On site disposal system ❑
SECTION 2: PROPERTY OWNERSHIP'
2.1 XCC3 tofRe)
Lcm �
UQ • Pr .}M Q.r �yl
Name(I)Wn) -°� City,State,ZIP
No.and StreetI Telephone Email Address . .
SECTION 3: DESCRIPTION OF PROPOSED WORK=(check all that apply)
New Construction❑ Existing Building❑ Owner-Occupied ❑ Repairs(s) ❑ 1 Alteration(s) ❑ 1 Addition ❑
Demolition ❑ Accessory Bldg. ❑ Number of Units Other ❑ Specify:
Brief Description of Proposed Work'':
SECTION 4:ESTIMATED CONSTRUCTION COSTS
Item Estimated Costs: Official Use Only
(Labor and Materials
1. Building $ Sid 1. Building Permit Fee:$ Indicate how fee is determined:
2. Electrical $ ❑Standard City/Town Application Fee
❑Total Project Cost'(Item 6)x multiplier x
3. Plumbing $ 2. Other Fees: $
4. Mechanical (HVAC) $ List:
5. Mechanical (Fire $
Suppression) Total All Fees:$
Check No. Check Amount: Cash Amount:
6. Total Project Cost: $
[3-00 0Paid in Full ❑Outstanding Balance Due:
SECTION 5: CONSTRUCTION SERVICES
5.1 C structtiio�n Supervisor License(CSL) r7/ s� ,7
( z"awl License Number Expiration Date
NNine of CSL Holder
Lis[CSL'Cype(see below) U
No,mid Street Type Description
U Unrestricted(Buildings up to 35,000 cu. 11.)
)) R Restricted 1&2 Fatuity Dwelling
Cityll'own,State,ZIP M Masonry
RC Rooting Covering
WS Window mid Siding
�] SF Solid Fuel Burning Appliances
a / ���,�"!1 �l�2pr, (,rf I Insulation
Telephone Email address D Demolition
5.2 R [ d Hormf lmpr ement Contractor(HIC) ��4,�, 1 ;llL
� � "' ; HIC Registration Number Expiration Date
HIC Co any Name or HIC Registrant Name
�OGDUZ CeJOo//'� <LO �J�—C �q
No.and��SSpp�ee[ Email address
y A2YyL "i d 3 07s
City/Town, State,ZIP Telephone
SECTION 6:WORKERS'COMPENSATION INSURANCE AFFIDAVIT(M.G.L,c. 152. § 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 ..........�<I No........... ❑
SECTION 7a: OWNER AUTHORIZATION TO BE COMPLETED WHEN
OWNER'S AGENT OR CONTRACTOR APPLIES FOR BUILDING PERMIT
I, 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.
Print Owner's Name(Electronic Signature) Date
SECTION 7b:OWNEW OR AUTHORIZED AGENT DECLARATION
By entering my name below, 1 hereby attest under the pains and penalties of perjury that all of the information
contained in this application is true and accurate to the best of my knowledge and understanding.
Print Owner's or Authorized Agent's Name(Electronic Signature) Date
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 not have access to the arbitration
program or guaranty fund under M.G.L.a 142A.Other important information on the HIC Program can be found at
N"vw.mass.wv:'oca Information on the Construction Supervisor License can be found at wvvw.mass.novidos
2. When substantial work is planned,provide the information below:
Total Floor 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"
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OSBORN PALMER 1911 - 1970
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DATE: *1Y 5- 26h
REFERENCE: ' .BR �u2 -PO 77 ChriaWpher R. Mello PLS 31317
104 LOWELL STREET
PEABODY,MASS.01960
(978)531-8121
FAX:(978)531-5920
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5Amanda Way
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10R x 10 Salem NH
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2x8 PT 16" O.C.joists
2-2x10 PT beam
36"rail height- Trex standard 3"o.c.
Ledger 112"bolt 12"o.c. in zig-zag pattern
10"sono-tube 4'depth min.