17 BARTON ST - BPA-15-348 REDECK The Commonwealth of Massachusetts INSPECTI HAL.C$fjR8jCES
� Board of Building Regulations and Standards SALEM
7 Massachusetts State Building Code, 780 CMR
Ise NS lq
1, d'
Building Permit Application To Construct, Repair, Renovate Or DemAMo Ish
One-or Two-Family Dwelling
ry This Section For Official Use Onl'
` ,J Building Permit Number: Date A lied:
, ! nuiiding Official(Print N.vne), Sigpattire, Date
t� SECTION 1:SITE INFORMATION'
rl 1.1 1� Proper Address: 1.2 Assessors Hnp&Parcel Numbers
1.1 a Is this an accepted street?yes_ no Map Number Parcel Number
1.3 'Zoning Information: 1.4 Property Dimensions:
Zuning District Proposed Use Lot Area(sq tl) Frontage(If)
1.5 Building Setbacks(R)
Front Yard Side Yams Rear Yard
Required Provided Required Provided Required Provided
1.6 Water Supply:(M.G.L c.40,§54) 1.7 Flood Zone Information: 1.8 Sewage Disposal System:
Public❑ Private❑ Zone: _ Outside Flood Zone? Municipal❑ On site disposal system ❑
Check if yesI3
SECTION2: PROPERTYOWNERSHIPi'
Record, )+
.v (}per
Iv�hme(Print) r City, tail
ZIP
rq r r�t� _ 2
No and Street Telephone Email Address
SECTION 3: DESCRIPTION OF PROPOSED WORK'(check all that apply)
New Construction❑ 1 Existing Building Owner-Occupied ❑ Repairs(s) Alteration(,) Addition ❑
Demolition ❑ Accessory Bldg.❑ Nu_mber of Units Other Cl Specify:
Brief escr'ption of Proposed Wor —414 c C� ' I^ a �'
IIV'f r
,
SECTION 4:ESTIMATED CONSTRUCTION COSTS
Item Estimated Costs: Official Use Only
Labor and Materials)
I. Building S I. Building Permit Fee:$ Indicate how fee is determined:
❑Standard City/Town Application Fee
2. Electrical $ ❑Total Project Cost'(Item 6)x multiplier x
3. Plumbing S P Qther Fees: S
4. Mechanical (HVAC) S List:
5. Mechanical (Fire ) Total All Fees:S
Suppression)
_ Check No._Check Amount: Cash Amount:
6.Tutal Project Cost: S - o ❑Paid in Full ❑Outstanding Balance Due:
5� 'o
SECTION 5: CONSTRUCTION SERVICES
f3.1 Construction Supervisor Licens:(CSL)
License Number Expiration Date
f
Name of CSL Holder
List CSL'fype(see below)
Type Description
No.and Street _
U UnnstricteJ(Buildings no to 35,000 cu. 11.
R Restricted M2 Family Dwelling
Citynown,Stale,ZIP URCRootin
CovcinalTele hone Email addressn
5.2 Registered Home Improvement Contractor(HIC)
HIC Registration Number Expiration Date
111C Company Name or HIC Registrant Name
No.and Street Email address
City/Town,State ZIP Telephone
SECTION 6:WORKERS'.CONIPENSATION INSURANCE AFFIDAVIT(M.G.L:c.15Z.§2SC(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 Isivance of the building permit.
Signed Affidavit Attached? Yes ..........❑ No...........❑
SECTION 7a:OWNER AUTHO1212A,T,[ON TO BE.COMPLETED.WHEN.?
OWNER'S AGENT OR CONTRACTOR APPI IES FOR BUILDING.PERMIT
I,as Owner of the subject property,hereby authorize
t9 act on my behalf,in all matters relative to work authorized by this building permit application.
Print Owner's Name(Electronic Signature) Date
SECTION 7b:OWNEW ORAUTHORIZED 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:
I. 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 LLoj have access to the arbitration
program or guaranty fund under 1M.G.L.c. 142A.Other important information on the HIC Program can be found at
www nciss.I.Ov'uea Information on the Construction Supervisor License can be found at www.mass.eov,'Jos _
2. When substantial work is planned,provide the information below:
'total floor area(sq. ft.) ' .(including garage,finished basementlattics,decks or porch)
Gross living area(sq. It.) 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"Tutal Project Cost"
i
7
Deck layout 1 � �
0 8 foot posts from deck floor
4 for privacy fence
House
■ Posts
■
4'
14'
0
landing ❑ ❑
Toverhang
16'
Old and new footings
n old
p new
House
0
� i 1
1 gI
O I I
I 1
1 I 14'
I
o p o a
1 1
13 4' 1 6' a 6' 13 4'
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