The URL can be used to link to this page

25 APPLETON ST - BPA-12-03 ROOFING/REBUILD CHIMNEY J The Commonwealth of Massachusetts , ,., to, ,.,. i1w ,;, .I ....•,• , Board of Building Regulations and Standards CITY OF Massachusetts State Building Code,780 CMR SALEM Revised Mar 2011 Building Permit Application To Construct,Repair, Renovate Or Demolish a One-or Two-Family Dwelling This Section For Official Use Only Building Permit-Number: I Date Appli G —Building Official(Print Name), Signature- Dad SECTION 1:SITE INFORMATION 1.1 Property Address:_ o L 1.2 Assessors Map&Parcel Numbers. ... rl,is 1.la Is tiloslan accepted street?yes no Map Number Parcel Number 1.3 Zoning Information: 1.4 Property Dimensions: + "' Zoning District Proposed Use Lot Area(sq ft) Frontage(11) 1.5 Building Setbacks(ft) i FrontYard,•t..) ')I t /t 'S+':+1. I SideYards'Ot A t;Oe PIT tAII IearYardII + If' _Required,,;, Provided ,Required Provided-: i, , Required —Provided 1.6 Water Supply:(M.G.L c.40,§54) 1.7 Flood Zone Information: t 1.8 Sewage Disposal System: Zone: - Outside Flood Zone? Public'❑ Private GB t! O i I # +v+' +:i f t 1Checkif'ye'sp 'f sr i Municipal❑'On site'disposal system ❑ h,s t SECTION`2:`PROPERTY OWNERSHH'' 2.1 Owner of Record: 1 1 .[dez Jl l-em ' `Mo- O 07a ' Name(Print) - '+' - ' City,State,ZIP 1 `' ' ' Qs ni • qi" -724 656 6e6vc4ma( e I +mlo No.and Street Telephone r Email Address SECTION 3:DESCRIMON OF PROPOSED WORIO(check all that apply) -New Construction❑" Existing Building❑- Owner-Occupied ❑ 1 Repairs(s) -Alteration(s) ❑ 1 Addition ❑ Demolition,+ • ' 'I❑ Accessory Bldg. ❑ Number of Units - Other ❑ Specify: '" ' Brief Description of Proposed Work :,f/ i 'Aft 94 SECTION 4:ESTIMATED CONSTRUCTION COSTS Item Estimated'Costs: . + aborandMaterials Official'Use Only { .t, `, 1.Building $ , 1. Building Permit Fee: $ Indicate how fee is determined: ❑.Standard Cityfrown Application Fee 2.Electrical $ w , , O ToW Project Cost?(Item 6)x multiplier x 3.Plumbing $ ay. 2. Other e s $ 4.Mechanical (HVAC) $ + • _ • + List: mk 5.Mechanical (Fire Total All Fees:$ " Suppression) $ ' 77 Check No. Check Amount: Cash Amount: 6.Total Project Cost: $ 8 p pad in Full ;, :,,:; ❑Outstanding Balance Due: do �v � SECTION 5: CONSTRUCTION SERVICES 5.1 Construction Supervisor License(CSL) ' ' t: ,_, , r, -4 ten . o: 601V31 : ,(J ��AQ-��1 4 r. , ',1 License Number Pxpiration Date Name of CSL Holder t ,+ -i List CSL Type(see below) ••�� ' •:,•7'. If°and Street Type ' Description. . . _ Unrestricted(Buildings.0 to 35,000 cu.ft. P-��o�h t' IA. -©��lmV Restricted M2 Family Dwelling ::",';0, City/Town,State,ZIP -. M - Masonry _ . ._ . .. _ RC Roofing Covering WS Window and Sidin I �i ]n . .SF Solid Fuel BuminglAppliances g(r7-`22 ! 22 �rI I- I Insulation Telephone A-- 1 ,- . Email address-, . r D Demolition , 1;1 er` :a.: 11 1 5.2 Registered Home Improvement Contractor(MC) /3��1� CS �iNy'" HIC Registration Number{' pi wn ate- HICCompanyName HIC Re rant NamerifI Iti p.f9 4.1 tcnitaan„itet' .�arz: e_,l NPZzzfsU!t YKA . OLR.�(7 /QJh'$ll/Q67 Email address :t ' 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'a........ 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 own�my�behalf,in all matters relative to work authorized by this building permit application: �Q,1U l 2- 2 26 Print Owner's Name(Electronic Signature) _ ate - SECTION,7bc OWNER'OR AUTHORIZED AGENT DECLARATION- _ a — By entering my name below,I 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,:r . t er' or Autho ' d Agent's Name(Electronic Signature) Date ,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(HIC)Program),will not hive access to the arbitration ;,: . program or guaranty fund under M.G.L.c. 142A.Other important information on the INC Program can be found at www:mass.env/oca-Information on the Constr uL{ion Supervisor License can be found at www.mass.eov/dos ' 2. When substantial work is planned,provide the information below: t Total floor area(sq.ft. "'' (including garage,finished basemenUattics,decks or porch) Gross living area(sq.4.) J ` Habitable room count r Number of fireplaces Number of bedrooms Number of bathrooms Number of half/baths Type of heating system t , Number of decks/porches Type of cooling system Enclosed Open 3. "Total Project Square Footage may be substituted for"Total Project Cosy'