20 BARCELONA AVE - BPA-10-476 REPLACE 3 WINDOWS The Commonwealth of Massachusetts
Board of Building Regulations and Standards CITY
Massachusetts State Building Code, 780 CW 7 th edition OFSALEM
Revs dJanuary
Building Permit Application To Construct, Repair, Renovate Or Demolish a 1, 2008
One or Two Family Dwelling
Number:, he _ppw
7
SEC N,,�t_J I T E, VQlkMAT
I pe ddr 1.2 Assessors Map&Parcel Numbers
U wpj:t
I.la 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(ft)
1.5 Building Setbacks(ft)
Front Yard Side Yards Rear Yard
Required Provided Required Provided —Required:::T: Provided
1.6 Water Supply: (M.G.Lc.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 13
Check if yesO
2.1 Owner !,�eco 4rd:
13 11
4 l_ +P- An4onkadp- C2 C) BGL(c C C)'Ao-
,
Name(Print) Address for Service: Is 0A C�m
.4,4!—L W) � . r)Ll L4 - l,0 0 Up
Signature Telephone
.A��RK (tIi al
New Construction 0 Existing Building 0 Owner-Occupied 0 Repairs(s) 4k Alteration(s) 0 Addition 0
Demolition 0 Accessory Bldg.13 Number of Units_ I Other 0 Specify:
Brief Description of Proposed Work , Jf1S'tafl C tf 12 1 QC 3f rnetl f 10 t 0 d 0 W--%
Y-)tD op�-,n k n C)
I
4
TR EST TED�'C
Estimated Costs: ..... ......
t-,Ofrbda
(Labor and d Materials) �Z3
1.Building $ how fee 4s dl d
—W
-I3,Standar&CftyJTown App icaft I off,I eFee
2.Electrical $
,-r, ,
'IN,
3.Plumbing $ Q
4.Mechanical (HVAQ $
5.Mechanical (Fire
Y-
'Y
Suppression)
'Check No Check Amount."'
6.Total Project Cost: $
—43❑Oupidading Paid In
` t `SECTION'S CONSTRUCTION SERVICES
5.1 Licensed Construction Supervisor(CSL) a G OC(D !•(q.L p J
Thrtmns _ h FWX License Number Expiration Date
Name of CSL-Holder
(� VJ Ce.(�Q r S� • O{9C,1I() List CSL Type(see below) L/
Address 'T e- ,y. ."� :'D858n Yton ' �. � :• '� '
U Unrestricted(Lip to 35,000 Cu Ft.
R Restricted 1&2 Fami!X Dwelling
Signature M Masonry Only
—7 V Q 3a 830 RC Residential Roofing Covering
Telephone WS Residential Window and Siding
SF Residential Solid Fuel Burning Appliance Installation
D Residential Demolition
5.2 Registered Home Imp ement Contractor(HIC)
WfC( �5g9
eU)R� D
HIC Company Name or HIC Registrant Name Registration Number
� � Ce � st lNon�l+•� S-�-Zol!
Addr
-7 V �Q 3aa $300 - Expiration Date
Signature Telephone
777777-7
" SECTION 6 IW(IRKERS''COMPEN5ATION INSURNCE AFF A H)AVIT(M G 13c tI52 §j25C(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 AUTHO ORIZATION T BE COMPLETED WHEN;:`
�OWNER' AGEN �R.00NTRACTVRA?PLIE3*ORSUIIDSNf.PERMIT
I, TM (,n d J U l 1 c"le Anb r_�tO�g as Owner of the subject property hereby
authorize k i Voi i 4Jrc_'� to act on my behalf,in all matters
relative to work authorized by this building permit application.
Si attire of Owner Date
�" '� �� SECTIOPi"/b,4WNEI21OR,AUTHORIZED`AG?✓NT;DECLARATIQN,k,,, '' `'r ' "_
I Th OYYI a S P• FGx Cal as Owner or Authorized Agent hereby declare
that the statements and information on the foregoing application are true and accurate,to the best of my knowledge and
behalf.
Th ornos P ro,X Orly
Print_ NUpe/
Signature of Owner or Authorized Agent Date _
(Signed under the pains and penalties of peri
����a€� +�ia;` .'�"` �< ,.._ `NOTES m. . � � t 'r - �:•
�1. An Owner who obtains a building permit to do his/her own work, or an owner who hives 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 and -
Construction Supervisor Licensing(CSL)can be found in 780 CMR Regulations 110.R6 and 110.R5,respectively.
2. When substantial work is planned,provide the information below:
Total floors 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"