10 BARTON ST - BPA-11-305 20 REPLACEMENT WINDOWS 1 } I
� Thr Cbmmumvc•rlth of Massachusctts �
� ;� Du�rJ ul'Building Regul•rtiun anJ StanJarJs CITY
� ' u, OF SALF'M
� �/ '� �� ' Massachuseus State Building Cal 780 CMR, 7 rJition
� Rrvi�'rd Jum�orl•
�` 13uilJing Prrmit Applicatiu Cunstruc , Repair, Rrnorrte Or Drmulish a l. :lNhY
U Un -or T�vu-Fu ilv Dwrlling
This ectio w ORcial Uu Onl
Building Pertnil Number: Date Applied: a
Signawre: �3a��
HuilJinyCummissione In � uf u diry{a f}rle
S ION I:SITE INFORMATION
I.1 Properry Addnsr. t.2 A�snson M�p dc P�rcel IVumben
O n �'�—
I.l a Is lhis an acce Itd�5lfcYl°yes no Map Number Poreel Number
I.J Zoatn�laformalbo: I.J Propertr Dlmeoslons:
Zuning District PropoxJ Use La Am(sq Il) Fromage(It)
I.3 Bulldlns Setbacks(11)
Front Yard SiJe Yuda Rear Ysrd
Reyuired PruviJed Requircd Provided Requi'ed � P�ovided
1.6 Water Supply:(M.G.L c.�0.§54) 1.7 Flaod Zooe tnfornutlan: t.8 Sew�Qe Dbpoaal Syrtem:
Public O Private O Z°"°: — a+uide Flaod Zone9 Munieip�l O On�ile dispmel system O
Cheek if a0
SECTION S: PROPER7'Y OWNERSHIP� .
.1 O ner�ot�ord: � �
-^ b �o �i�-�h �i S.�l�., �or9 0
Nome( Q � AJd�ev fw Service: q
� � \ 97�. 7`/��� 7� / '�
i urc Telephone
SECTION J: DESCRIPTION OP PRO�U3ED WORK�(checic aU t6�t�pply)
New Construction O Existing Building❑ Owner-Occupied O Repairs(s) O Alteration(s) ❑ Addition O
Demolition ❑ Accessory Bldg.O Number of Unip Other O Speeiry: �
Brief Dexription of Propoud Work':
��
r��,��P:,.s.�� i,i�� x,.u, �— ao
SECTION/: ESTIMATED CONSTRUGTION COST9
I�em Estimated Cosu: ORlclal Uae Only
Labor and Materials
1. Duilding - S I. Uuilding Permi�Fee:f Indicate how fee i�detertnined:
O Standard Ciryl�own Applica�ion Fee
?. Elec�rical S ❑Total Projat Cosl�(I�em 6)� mulliplitt x
l. Plumbing 5 2. Other Fea: S
1. Mechanical (HVAC) E LisC .�
5. Mechanical �Fire S
Su ression Tutal All Fees:f
6. Total Project Co.ff: S aT � Check No. Check Amounc Cuh Amount:
`� J 00 ❑Poid in Full O Outs�anding Balance Due:
t
� ..��U
{ �
tiECT10N S: COIVSTRUCTIOIV JERVICES
S.1 Llcemed Comtruc�loa Supervbor ICSL)
� I.iccnx Number litpiralion Uate
�.. N�une ol Ctil.•IIuIJer I.is�l'SL-fype 1�belnw)
� Uacri ion
,WJmss U tlnmlricleJ u tu73,000Cu.F1.
R Res�ricted Id2 Famil Ihvellin
� tii�{nuwrc M M• (hJ
RC Raidemiol Roulin �'overin
1'.IcpMme WS RaiJrn�ial WinJowanJSiJin
tiF ResiJential Sulid Fuel Bumin A IIDIINC IIIYIiIIJIIUII
D RniJrn�id Demo�iiion
3.2 Retbtered Home Improvemeot Cootnetor(HIC)
I IIC Company Namc ur k11C Regia�r�nt N:une Regisua�ion Number
' AJJress Eapira�ion Da�e
tiiynwlure Tclephune
SEGTIOIV 6: WORKERS'COMPENSATION INSURANCE AFFIDAVIT(M.G.L.a 152.� 23C(6))
Worken Compmsetion Insurance alTidavit must be complded and submitted with this application. Failure to provide
this afTidavit will result in�he deniel of the luuance of the building permi�.
Signed A�davit Attaehed7 Yd ..........O No...........O
SECTIOIV 7�:OWNER AUTHORIZATION TO BE COMPLETED WHEN
OWNER•S AGENT OR CONTRACTOR APPLIES FOR BUILDING PERMIT
� , as Owner of�he subjec�property hercby
authorize to act on my behalf,in all metten
relative to work authorized by this building permit application. �
Si umofOw�rcr pote
SECTION 7 • OWNER�OR AUTHORI2ED AGENT DECLARATION
. � �— � ,av Owner or Authorized Agent hereby declare
Ihat lhe statements G infortnation on�he foregoing application nre We and accurale,to the best of my knowledge and
behalf.
8P�- - �-� h -�l
Print Name .�/� � � /)// _ L `�—
,C1��— /% G" LS � �/
� Signutum ol'<hvner a A ori Agent Ihte
� Si unJer�he airo and mltief ol' 'u
nores:
1. An Ownar who ubtains a building permit lo do his/her ow�work,or an owner who hiro an unrcgis�ered cuntrector
(not rcgistercd in the Home Improvement ConVactor(HIC)Program),will�Q(have access to the arbilra�ion
progrrm or guarrnty fund under M.G.L.c. 112A.Othcr important information on�he HIC Progrrm and
Conslruclion Supervisor Licensing(CSL)can be found in 780 CMR Regulations 1 IO.R6 and 1 IO.RS, rcspectivrly.
? Whtn substamial work is planneJ,provide the inf'orma�ion below:
To�al Iloon area(Sq. FI.) (including guage, finished bazemenUattice,decks or porch)
Grosf living area(Sq.FI.) Flabilable room count
Number of fircplace� Number ol'bedrooms
Number of ba�hroum� Number of halUbatha
Type uFheating system Number of Jecks/purche�
Ty�pe of cwling sys�em � Encloxd ��p��
J. "Tuial Project Syuare Fuo�age"may be substiw�eJ for'Total Projrct Cos�"