8 BARTON ST - BPA-11-446 BASEMENT WORK, NEW WINDOWS The Commonweal;huMassachuscus
t, l Board ul'Building Rens and Standards CITY
Massachuscus State Buildine, 780 CMR, 7'"edilion OF SALEM
Rrrirrr/lunurrrr
Iuilding Permit Application To ConstRepair, Renovate Or Demolish a /. :IRAV
One-or Twu-FDwelling
This Section ficial Use OnlBuilding Permit Number: e Applied:
Signature: I r
Huilding Cummi wnen In o of Buildings t}aq
SECTION 1: SITE INFORMATION
1.1 Property Address: 1.3 Assessor Map A Parch Numbers
I.to Is this an accepted sine?yes no Map Number Parcel Number
1../ Zoning Information: 1.4 Property Dimensions:
Zoning District Proposed Use Lot Area(s ftl) Fronmge 111)
1.5 Building Setbocka(R)
From Yard Side Yards Rear Yard
Required Provided Required Provided Required Provided
1.6 Water Supply:(M.G. c.40,§54) 1.7 Flood Zone Information: 1.8 Sewage Dlsposal System:
Public❑ Private❑ Zone: — Outside
tsid Check iF 1 d Zone' Municipal❑ On slit disposal system ❑
SECTION 2. PROPERTY OWN6RSHIP1
oNew
wnert of Record' (y
CfOifly l 'n(AQI � 1J✓�l �C't(1
IP,yint) _ A fo Service:
ZA1 e Tel phoneSECTION J: DESCRIPTION OP PROPOSED WORKS(check aU that apply)
onstruction❑ Existing Buil ' Owner-Occupi Repairs(s) ❑ Alteration(s) ❑ Addition ❑
Demolition ❑ Accessory Bldg. ❑ 1 Number of Units Other ❑ Sp'City:
Brief Description of Proposed Work': �. 1
SECTION 4: ESTIMATED CONSTRUCTION COSTS
Item Estimated Costs: O/Ilclal Use Only
Labor and Materials
1. Building S 1. Building Permit Fee: f Indicate how fire is determined:
�. Electrical S ❑Standard City/Town Application Fee
❑Total Project Cost'(Item 6)..n multiplier x
). Plumbing S 2. Other Fees: S /f� ���
4. Mechanical (fIVAC) S List: /
3. Mechanical (Fire
Suppression) S Twat All Fees:S
1 s`� Check No._Check Amount: Cash Amount:
6. Total Project Cost: S 1. (�/(J ❑Paid in Full O Outstanding Balance Due:
SECTION S: CONSTRUCTION SERVICES
S Licensed Construction Supervisor(CSL) r� Jp��
a in ✓� n,, /� fwi nsee Number I:a inliunI ate
� A K atn h � ` ��-----
Name of C51.• I lolder - 'st C'SL rype(see below
Description
U i Unrestricted to 33.000 Cu.Ft.
Restricted Id2 Family Ihvellin
. ityulure M M Onf
RC Residential Routine Covering
WS Residential Window and Sidin
aic ine SF Residential Solid Fuel Bumin Appliance Installation
D Residential Demolition
S Istered Gate Intpro amen gontrac r( IC) \oLa (�
Registration Number
IC C t>,srty N IIIC iatrant Nine
� 2A z�
d is - Erpirati6n Date
cleph ne
,'ignature
SECTION 6: WORKERS'COMPENSATION INSURANCE AFFIDAVIT(M.G.L.C. IS7. f MOD
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? Yea ..........O No...........O
SECTION 7a:OWNER AUTHORIZATION TO BE COMPLETED WHEN
OWrNER'S AGENT OR CONTRACTOR APPLIES FOR BUILDING PERMIT
1, 1 GS a rize
9 as Owner of the subject property hereby
to act on my behalf,in all matters
relative towork authori by this bull g permit application.
01
Si re of Owner Dote
SECTION 7b: OWNEW OR AUTHORIZED AGENT DECLARATION
l -- ,as Owner or Authorized Agent hereby declare
that the statements and information on the foregoing application arc We and accurate,to the best of my knowledge and
bah -
� r�9N
Signature of(honer or Authorized Agent Da�aV""e
Si under the ins and hies of u
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 dg have access to the arbitration
program or guaranty fund under M.G.L.c. 1 42A.Other important information on the HIC Program and
Construction Supervisor Licensing(CSL)can be found in 7R0 CMR Regulations 110.116 and 110.RS,respectively.
2 When substantial work is planned.provide the information below:
Total floors area(Sq.Ff.) (including garage, finished basement/amics,decks or porch)
Gross living area(Sq.Ff.) 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
). "Total Projat Square Footage"maybe substituted for"Total Project Cost'