9 BALCOMB ST - BPA-16-442 REPLACE FRONT STAIRS & LANDING (002) 2T5 c�
The Commonwealth of Massachusetts li C�V
Board of Building Regulations and Standards dSPgG?10 IAL (KB
Massachusetts State Building Code, 780 CMR Revised Mar 2011
Building Permit Application To Construct, Repair, Renovate Or DernV141 `( -2 P 2 01
One- or Two-Family Dwelling
This Section For Official Use Only
`:ti Building Permit Number: Date Appli
�- 1. 3 /
n Building Official(Print Name) 5q. Y: _ - Signature, bate
Vt SECTION 1: SITE INFORMATION
1.1 Proper' Address: S� 1.2 Assessors Map& Parcel Numbers
1.1 a Is this an 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)
Front Yard Side Yards Rear Yard
Required Provided Required Provided Required Provided
E6 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 if yes❑ Municipal ❑ On site disposal system ❑
SECTION 2: PROPERTY OWNERSHIP''
2. /Owne 'of�i ord:
p1f (�}a
N e(Print) f{� r; City, State,ZIP
\COVti� 916—Ct19 -z-01A(s
No.and Street Telephone Email Address
SECTION 3:DESCRIPTION OF PROPOSED WORK'(check all that apply) ,,A 1,`
New Construction ❑ Existing Building❑ Owner-Occupied ❑ Repairs(s) ❑ 1 Alteration(s) ❑ 1 Addition ❑
Demolition ❑ Accessory Bldg. ❑ Number of Units Other ❑ Specify:
Br' f Description of Proposed Work':
KO r�) �cic SDI M� Sint
r " ":',SECTION 4:ESTIMATED CONSTRUCTION COSTS
Item Estimated Costs: Official Use Only °t ,
Labor and Materials
1. Building $ � �j (� I. Building Permit Fee $ Indicate how fee is determined:
❑ Standard City/Town Application Fee
2.Electrical $ ❑ Total-Project Cost'-(Item 6)x multiplier-,v i,. x '
3.Plumbing $ 2 Other Fees:,$
4.Mechanical (HVAC) $ L[st (
5. Mechanical (Fire $
Su ression 'Total All Foes $
Check No hA -Check Amount Cash Amount
6. Total Project Cost: $ 3 I($(() ICU ❑paid in Full 1-,0 Outstanding Balance Due:k; ."
c
6(<Jv
SECTION 5: CONSTRUCTION SERVICES
5.1 Constrgction Supervisor License(CSL)
��M'bc,Lua i C5F/� o�Sy�s/ � J '0I Ib C hc4t `' � License Number Expiration Date
Name of CSL Holder
2 o, , �.1 C� a f' _ List CSL Type(see below)
No.and Street M Type Description -
7�)G.V\\.J �n 2i3 Unrestricted(Buildings up to 35,000 cu.ft.)
Restricted 1&2 Family Dwellin
City/Town, State,ZIP M Masonry -
RC Roofing Covering
WS Window and Siding
cc \ n /�^ SF Solid Fuel Burning Appliances
gl$`»l'Or1Z7 JIMCI �122, Ar JASt,r+ Coy, I Insulation
Telephone Email address D Demolition
5.2 Registered Home Improvement Contractor(HIC)
ChaA- �e�,b�Ws�� gig g ra �6
HIC Registration Number Expiration Date
HIC Cogr�p 1y�TName�.QyHIC Registrant Name
�v ri 11���6 sMD ga A msN - c6w,
.Ng.and` Stvr 4e N O(qn 9TK '1.�- Email address
City/Town, State,ZIP I 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 .......... Er' No........... ❑
SECTION 7a: OWNER AUTHORIZATION TO BE COMPLETED WHEN
OWNER'S AGENT OR CONTRACTOR APPLIES FORE BUILDING PERMIT
],as Owner of the subject property,hereby authorize C k(2 5' &- J2 m W W>�'
to a ton my behalf, in I matt s relative to work authorized by this building permit application.
Print wner' Name lectroni ig ure) Date
SECTIO ;7ti- OWNER'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 to the best of my knowledge and understanding.
Print Owner's or Authorized 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. og v/oca Information on the Construction Supervisor License can be found at www.mass.gov/dQs
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"
CHET DEMBOWSKI & SON d.S Lcw\c�uoL
GENERAL CONTRACTING SHEET NO. OF
LICENSED & INSURED
P.O. BOX 412 CALCULATED BY DATE
DANVERS, MA 01923 CHECKED By DATE
(978) 777-0927
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AND CONFORMS TO THE ZONING LAWS OF THE TOWN OF ALE
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WITHIN THE FLOOD HAZARD ZONE AS T.
DELINIATED ON MAP 2001 VTP ASSOCIATES INC.
COMMUNITY ZSO/o2 -ooa/g 292LANGLEYAD-
NEWTON CENTER,MA 02159.2327 C/8TE
THIS PLAN NOT MADE FROM AN INSTRUMENT SURVEY, (6/7)332d271 (6M 965d670 ,NO OUR-,,
NOT TO BE USED FOR FENCES,ETC.FOR USE OF BANK ONLY. NATICK 156e(953-9650
TEIEFAX (617)969-23 30
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DATED RECORDED IN s Fx so
REGISTRY OF DEEDS- SA<diy7 BOOK , PAGE PGEO sa70- '7a3
I HEREBY CERTIFY THAT THE BUILDING SHOWN ON THIS PLAN IS LOCATED ON THE GROUND AS SHOWN,
AND CONFORMS TO THE ZONING LAWS OF THE TOWN OF 5i9L�M
I CERTIFY THAT THIS LOCUS DOES NOT LIE ���ZH OF y,
WITHIN THE FLOOD HAZARD ZONE AS 9 c`ov9GCQ'WZF 5� yo+ ANTHONY''�y��
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COMMUNITY 222 LANGLEY AD, No,yaO3 JI
NEOVTCN CENTER,MA 02159.2327
THIS PLAN NOT MADE FROM AN INSTRUMENT SURVEY, (917)2324271 (617)904407C
NOT TO Oe USED FOR FENCES, ETC.FOR USE OF BANK ONLY. NATICK (800)es&9999
TELEFAII (817)989.2130