31 ARBELLA ST - BPA-12-187 REBUILD F & B DECKS & STAIRS 1 The Commonwealth of Massachusetts
Board of Building Regulations and Standards CITY OF
i Massachusetts State Building Code, 780 CMR Revised Mar 2071
SALEM
Building Permit Application To Construct,Repair, Renov Demobs
One-or- Two-Family Dwelling
This Section For Official U Only '.. . .. - -
.Building Permit Number: I-Date Ap ed:'
Budding Official(Print Name) Srgnature Date
SECTION 1: SITE INFORMATION _
1.1 Property Address: 1.2 Assessors Map&Parcel Numbers
3i .Artiello. Sft Salei, MA OIg30 76 _0346 - 0
1.1a Is this an accepted street?yes--Y. no Map Number Parcel Number
1.3 Zoning information: 1.4 Property Dimensions:
R2 R2 2148
Zoning District Proposed Use Lot Area(sq ft) Frontage(ft)
1.5 Building Setbacks(ft)
Front Yard Side Yards Rear Yard
Required Provided Required Provided Required Provided
t5 1 b to f{ I S H 7o F+ 114 4
1.6 Water Supply: (M.G.L c.40,§54) 1.7 Flood Zone Information: 1.8 Sewage Disposal System:
Zone: b Outside Flood Zone?
Public�1 Private❑ Check if yes❑ Municipal 03 On site disposal system ❑
_ ; r SECTION 2: -PROPERTY OWNERSHIP' "
2.1 Owner'of Record:NI(aie 1Rmrlei'fA MA 01970
Name(Print) City,State,ZIP
2 mfk&� S} 181 -20 - D845 +Dny�J ly iy arl� f-t l'r.
No.and Street Telephone �Finail Address
` SECTION 3:.DESCRIPTION OF PROPOSED WORICZ.(check all that apply) - "
New Construction❑ Existing Building 2T Owner-Occupied ❑ 1 Repairs(s) 0, Alteration(s) Nr I Additi-o ❑
Demolition ❑ Accessory Bldg. ❑ Number of Units Z Other ❑ Specify:
Brief Description of Proposed Work : re b 61101 ± r rS "' A
ovC,r- StnIr3 -
S12fCX1A Pt I h 11sf4;_V6+7zPh o rcaP--
Lc.1c ,
SECTION 4:ESTIMATED CONSTRUCTION COSTS
Item Estimated Costs:
(Labor and Materials) Official Use Only
1. Building $ 1 oci 0 1 Building Permit Fee:$ Indicate how fee is determined:
❑Standard City/Town Application Fee ._.
2. Electrical $ .
❑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: $
Ott 0 Paid in Full `-❑ Outstanding Balance Due:.'
SECTION 5: CONSTRUCTION SERVICES
5.1 Construction Supervisor License(CSL) C5 103993 7ho/7o13
Ain A r C, n U t.l to,; License Number Expiration Date
Name of CSL Holder
8-1 ' � 1^ �� ,-Z List CSL Type(see below)
I�WQr ' N
No.and Street T e+ Description
s�w' WM C Ct � Unrestricted&2 Family
(Buildings u el ing cu.ft.
` Restricted I&2 Famil Dwelling
City/Town,State,ZI1P, 2 M Masonry
S 5 > RC Roofing Covering
WS Window and Siding
1 Nor+'Nw%n of SF Solid Fuel Burning Appliances
z411 °153 -o N I QLA, 16 11 n.a 1I ekC .S LLG I nsulation
Telephone Email address ' D Demolition
5.2 Registered Home Improvement Contractor(HIC) 16Li$g G 11 ;v it
Ay-. .Al Cq 1170n; HIC Registration Number Expiration Date
HIC Company Nam� e or HIC Registrant Name
2k-7 lA"311 S 4641�t, nog twt �l 6. %1A0 s «.,o0-,
—
No.and Street Email address
show, Wly') o19`io 7�1 95°� oK`{(
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 ..........P11, No ...........❑
^^' .SECTION lac OWNER AUTHORIZATION TOBE.COMPLETED WHEN
`=1 OWNER'S AGENT OR CONTRACTOR APPLIES FOR BUILDING PERMIT . .".
I, as Owner of the subject property,hereby authorize Tan V Ba rl t t' -p,
to act on my behalf,in all matters relative to work authorized by 1his building permit application.
to 1 C.o'I L Ria r"t C*t? S Zv 1 1
Print Owner's Name(Electronic Signature) Date
-- SECTION 7b:OWNEWOR AUTHORIZED'AGENT.DECLARATION'
By entering my name below,I hereby attest under the pains and penalties of perjury that all of the information
contained in this applic ion is true and accurate to the best of my knowledge and understanding.
/& La 1
Print Owner's or A orized 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 have access to the arbitration
program or guaranty fund under M.G.L.c. 142A. Other important information on the HIC Program can be found at
www.mass.eov/oca Information on the Construction Supervisor License can be found at www.mass.eov/dos
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"