35 ARBELLA ST - BPA-13-759 REMOVE INTERIOR CHIMNEY Ck --ff 5V87
The Commonwealth of Massachusetts CITY OF
WBoard of Building Regulations and Standards SALEM
Massachusetts State Building Code, 780 CMR Revised Mar 2011
Building Permit Application To Construct, Repair, Renovate Or Demolish a
One or Two-Family Dwelling
B ujldijigPerrit,Nqmbef , Date Applied
p,l d
Signature
>=Date.
Building Offic at IP ii
SEfqioN1, E)NFORMA
;
1.1 Property Address: 3 Vrb d1,a !�- 1.2 Assessors Map&Parcel Numbers
L l a Is this an accepted street?yes X= no_— Map Number Parcel Number
1.3 Zoning Information: 1.4 Property Dimensions:
Toning—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
1.6 Water Supply: (M.G.L c.40,§54) 1.7 Flood Zone Information: _1_.8—Sewage Disposal System:
Public 0 Private 0 Zone: Outside Flood Zone? Municipal 0 On site disposal system ❑
Check if yesO
SI 11�1111 4. " , ' , , , , '��C,;; -��, 1� I-,'
`PRQPI�4TYt,'OWNERS, - - �,��� �, �4� , t�T10 '2
2.1 Owner'ofRecord-
e-4c," (-,�q , (--a I,e", A
Nam•maec(�Plllo City,State,ZIP
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'3 5-4r 12-,LO 2S��AL95_4 0 "Wi- 5
No. and Street Telephone h1mail Address
1
2
�ylq��_(cbeck all that apply}
§ECTI,ON-3,;,D,ESCRIPTIOI�,!QFPROPOS,ro
New Construction Cl I Existing Building Owner-Occupied Repairs(s)* I Alteration(s) E Addition
Demolition 0 Accessory Bldg. El Number of Units— Other 0 Specify:
Brief Description of Proposed Work':
SFCtION4:, TIlAttD.CONSTRI TION,
ES JC
Estimated Costs: !'
x�
%
-,,k. .. Offi&dl,Use'Only�-
Item (Labor and Materials)
fee is:deterffiined:-❑ ,
1. Building $ 1 Building Permit Fee $ Indicate how
Standard Cit w
y/,T6Wn Alip ication Eee
2. Electrical $ 3800.00
❑Total Protect CostE 3(1'
tern
3. Plumbing $ 19. 00
4. Mechanical (FIVAQ
by
5. Mechanical (Fire
Total All Fees..$,,_,_ '
Suppression)
Check 0 t::' Cash Amount'-'-
'
6. Total Project Cost: eO&'. 0,)- �O'Pa_ -
Paid in:Full Outstanding Baldrics,Due:'
d;? CZ01 A .4o #00"euftcl__�
SECTIONS: CONSTRUCTION SERVICES'
5.1 Construction Supee isor License(CSL)
License Number Expiration Dale
Name of CSL Holder
, List CSL Type(see below)
r I3yi a�P 57.
No. and Street ,Type `.Descnption
5v -ew, /�/��. 0� 9�6 U Unrestricted(Buildings�u p to 35,000 cu. ft
Olo A. R Restricted 1&2 FamilyDwellm y
City/Town, State,ZIP M Masonry
RC Roofing Covering1
WS Window and Siding
�/1"_>(JY-��� /+^ate 3;/ �7 SF Solid Fuel Burning Appliances
7 t�J ��j/� .G0,11C4 I Insulation
Telephone Email address D Demolition
gistered Hoy/t/jlmpro/Yemen[Contractor )�3D&S� /U
eK /ram/°�'��N 41,�//N�Pr��YSt'17Ph ' F/— Registration Number Expiration/Date
HIC�o od
mp�j;arr� rHlSjtegistrant Name
No,yndyStreet &V
S �1� Email address
/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 .......... 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 Pew 2 Y M r C, aailC
to act on my behalf, in all matters relative to work authorized by this building permit application.
Jr,P'o wt -P �u r �i° U ��t/5 /� � � 1111311
Print Owner's Name(Electronic Signatur Date
I,
SECTION 7b: OWNEW OR 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 application is true and accurate best of in kno edge and understanding.
e- er Addat4d /3 /3 -
Print-&=F's oCAulhorized Agent's Name(Electronic Signature) Date
NOTES:
1. An Owner who obtains a building permit to To 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 can be found at
www,mass.?ov'oca Information on the Construction Supervisor License can be found at w�vklDs
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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All dimensions size designations 2020:7'1 This is an original design and must Designed: 4/5/2013
given are subject to verification on TECHNOLOGIES M not be released or copied unless Printed: 4/5/2013
job site and adjustment to fit job applicable fee has been paid or job
conditions. order placed.
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