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3 ARTHUR ST - BPA-14-289 WINDOW REPLACEMENT 2 SI - i q $ Lfoo The Commonwealth of Massachusetts CITY OF h Board of Building Regulations and Standards SALEM t Massachusetts State Building Code, 780 CMR AL �,.✓� Revised d&ir 20/1 R Building Permit Application To Construct, Repair, Renovate Or Demolish a One-or Two-Family Dwelling This Section For Official Use Only Building Permit Number: Date.Ap l !© J3 Bin ding OIT3ci• (Print Name). Siggafure Dnte SECTION 1 SITE INFORMATION 1.1 Property Address: 1.2 Assessors Map& Parcel Numbers 3 A-rZ S•[-r�4- 1.la Is this an accepted street?yes no dfap Number Parcel Number 1.3 Zoning Information: IA Property Dimensions: Zoning District Proposed Use Lot Area(sq It) Frontage(II) 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: Zone: _ Outside Flood Zone? Public❑ Private❑ Check ifyes❑ Municipal❑ On site disposal system ❑ SECTION2: PROPERTY OWNERSHIP'' 2.1 Owners of Record: K(Pelvin AC-6j'a411 Godeet l mA o ig70 Thme rint) City,State,ZIP 3 A,--Pk vl- 5} q -7g- 70"M3 No.and Street Telephone Email Address SECTION 3: DESCRIPTION OF PROPOSED WORK'(check all that apply) New Construction ❑ Existing Building❑ Owner-Occupied ❑ Repairs(s) ❑ Altemtion(s) ❑ Addition ❑ Demolition ❑ Accessory Bldg. ❑ Number of Units Other Specify: Brief Description of Proposed \York': 'L/tf-WI onevf%j) ► �elacen�2 1 b wfndo�y- Ajo s&LUcC_ �a G ce SECTION 4: ESTIMATED CONSTRUCTION COSTS Item Estimated Costs: Official Use Only Labor and iblaterials) I. Building S 6A1 — I. Building Permit Fee:$ Indicate how fee is determined: ❑Standard City/Town Application Fee ?. Electrical S ❑Total Project Costs(item 6)x multiplier x 3. Plumbing S 2. Other Fees: 4. .S 4. Mechanical (FIVAC) S List: 5. Mechanical (Fire S Su ression) "total All Fees:S Check No._Check Amount: Cash Amount: 6. Total Project Cost: .S (Q z J ❑Paid in Full ❑Outstanding Balance Due: !1�1cuQh et SECTIONS: CONSTRUCTION SERVICES 5.1 Construction Supervisor License(CSL) l q?q AL�An �o(otll License Number Expiration Date Nome of CSL holder List CSL"type(see below) ti 3 Ghe-rs4iaA Or lStreet Type Description No. Laid . WOLrk,a NH 03063 U Unrestricted Buildin s UD to 35,000 cu. It.) R Restricted 1&2 Family Dwelling Cityi I'own,State,ZIP - M Masonry yG RC Roofing Covering WS Window and Siding po SF Solid Fuel Burning Appliances 3 Y3 9 I Insulation Telephone Email address D Demolition 5.2 Registered Home Improvement Contractor(HIC) f Fo vJ 2(- MR 02,0^.0dp.l I/I A Q/-OYP HIC Registration Number F.s ratio Date 111C Company Name or HIC Registrant N:mi SP 0/ No.and Street Email address Che.r�FernA 6Ro13 b,lo- 8�Y-5vo 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 Wuance of the building permit. Signed Affidavit Attached? Yes .......... 91 No...........❑ ,, 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 A)j art Co I e tffs PI A?=q t9 act on my behalf,in all matters relative to work authorized by this building permit application. I Kevin Mc&-rrik See. Ca/I YRC'y g!k=9- 13 Print Owner's Name(Electronic Signature) Date SECTION 7b:OWNERI 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. / flan Co I, / rN,2G1 IO/r!/? Print Owner's or Aut orized 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 b1.G.L.c. I42A. Other important information on the HIC Program can be found at www.mas,.gov+'oca Information on the Construction Supervisor License can be found at www.nmss.gov/,Ss i. When substantial work is planned,provide the information below: Total floor area(sq. it.) (including garage, finished basement/attics,decks or porch) Gross living area(sq. R.) Habitable room count Number of fireplaces Number of bedrooms Number of bathrooms Number of half/baths Typo of heating system Number of decks/porches Type of cooling system Enclosed Open 3. "Fot;d Project Square Footage"may be substituted for"Total Project Cost'