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1 BARNES CIR - BPA-13-101 ROOF _ --- I he C'ummomso;lhh of llv1:uwchusclls I)oard of I)uilding Regulations vtd Standards CITY Of {{ all r Nfassarhusotts State Building Codill CNIR SALEM 1` Building Permit Applicalinn To Construct. Repair. Renovate Or Demolish a One-or Tn o-Fiunily Uu cllnn%( This Section For 011iciul U••Ont Building Permit Number. Date Applied.. / Iluildiny Ulslcial(print N:une) Signature r Date SECTION I: SITE INFORMATION L I Prop ray lddress: C 1.2 Assessursflap& Parcel Numbers I.la Is this an accepted street?yes no '�fnp Numhcr purcel-Num,-r IJ Zoning Information: 1.4 Property Dimensions.- 71111119 imensions:71111119 0131ricl Frt pa,cd(Jaw Lot Area IA RI Frani se(R) 1.3 Building Setbacks(R) Front Yard Side Yams Rcar Yard Required Provided Reyuircd Provided Rcyuind provided 1.6 Water Supply:(M.G.1.c.JU,§54) 1.7 Flood Zone Informadon: 1.3 Sewage Disposal System: Public O Private O Zona: _ Outside Flood Zone? Check iY p0 Municipl On site disposal s).vlem O SECTION I. PROPERTY OWNERSHIP' 2.1 Owners o(Record: /YL 4 f2/ A I IF R R D S9'I e.vt N;mw(Prim) C u).SIaW.l.IP 1 f� Nu.unJ Street rcicphune F.mail Address SECTION J: DESCRIPTION OF PROPOSED WORK'(check all that apply) New Construction❑ Existing Building❑ Osvner•Occupied ❑ Repatrs(s) O Alteration(s) C3 Addition O Demolition O Accessory Bldg,a Number of Unib_ Other rl .Spceity; Brief Description of Proposed Work% e! v L ti SECTION 4: ESTIMATED CONSTRUCTION COSTS heist Estimated Costs: N allor and.Materials) OMCIAI Use Only I. Building S 1. Building Permit Fee: S Indicate how lee is deterstined: l lectrical S ❑Standard Ciry-Toan Application Fee t. I'lumhptg S O Total Project Cost'(,tem 6).x multiplier - _. Usher Fees. S- J. \Irch,mi:,al ill% Ul S List: \Iccil-mie.d t hrc _ ,ro ion) S total 'AIl Fees; S .11 �6 l'ol:rl Project Cast: i (hcck No. --..__( . . — \annum: S �S a ❑P.tid in Full ❑outstanding Bal.mcc Due: �- SEA-1IO,NS: CONSI'R11f"TIONSERVICYS l S,I C'onstruvtiunSupenisurLicense(CSL) rQ S 3Y 11W7 3 —._ Q I Iccnec Number f.piralnal Mile Nanlc ui t'SL I la6lcr I 1.11 CSI. 1'.pc hvv - 1 I•+p I)cicriplinn N,r .u1J sirvut t UnrestriduJ I lluddin s li ret li,lllltl a1. Il.l G� Li ye ("C �Ql, ©Z ( Y It ItalricteJ 1:0?Tamil 1)s+allin l7 C'it)—;r..... Slate.LII' RC Ra.nin L'o.vrinst W'inJunv.mJSidin SF Sulid fuel Ihlming Applialtces ' . 3 I z Insululion Clmlil aJJrv.+ l) Dcnlulitiun 1'u lc bene S1 Registered Ilume Improvement Contractor(NIC) &/91L3 ,v i U, YQ d S14dT/'b I11('I�lit I..Plruuun Uu1e 11 1pall Name or III 'I •gi,trwl Nanta A A.t'A z>✓ Cmu11 •' address No and Street I j Z y+ Et.erclfi- N� Ci /Town,State ZIP Tele hone SECTION 6t WORKERS'COMPENSATI-::NSURANCE AFFIDAVIT(M.G.L.C. 153. 3SC(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•••••••• O SECTION 7a: OWNE11 R AUTHORIZATION TO BE C011IPLETED WHEN OWNER'S AGENT OR CONTRACTOR APPLIES FOR BUILDING PERMIT I, as Owner of the subject property,hereby authorize L Q V D 1-0 to act on my behalf,in all natters relative to work authorized by this building permit appllco(nn- 1 17--Zi e r Y'g' Date print Own& b Nome(Elcutruntc Signature) SECTION 7b:OWNEROR 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. vl e 1, naw I'rin11 cr'i.la:\ulharliv Nanw(IJ.ctnnu� Slgn uun) NOTES: 11 I. .\n Ovine who obtains a building permit to do his.her own work,ur an owner who hires an unregistered eummcwr Ant registered in the Hunte Improvensem Contractor(HIC) Program),will nu have access to the arbitration prograns or guarant) fund under NI.G.L.c. IJ?.>.Other inlpunant information on the HIC Program can be Ii1wtJ a1 ..s,. 111.111 0. '. I Information on the Construction Supervisor License can be found at%-1%2. \\'hen substantial work is planned,pr Nius the information below: IRI - __ 1 including garage. linishcd basement attics,decks or porcht Total flour arca I sy. C irosi li.ing .trea 14ILI _... . Habitable room count --- - \umhcral'bcdrusnlls \anther oflireplaccs _. ._ -- Number ofhall'hathi \ttwhcrafhalhreoms - . . \unlhcrafdecks porches IN pc of ltcatlllg 3),101t I�IIeIV.eJ ,til+elf 1\pe of cooling :):Ica t, "I,,ial Project Square Footage IM's be wh.tiudcJ for •fatal Project Co.t-