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6 BAY VIEW AVE - BPA-16-1278 NEW KITCHEN, BATH, 8 WINDOWS 'rhe Commonwealth of Massachusetts 9, CITY OF i Board of Building Regulations and Standards SALEM Massachusetts State Building Code, 780 CMR Revised blar 2011 (� Building Permit Application To Construct, Repair, Renovate Or Demolish a One-or Two-Family Dwelling This Section For Official Use Only Building Permit Numbee Date Applied: I building Otticial(Print Name) Signature '_ - - Date if�(l SECTION I:SITE INEORb1ATIOW IL"J 1.1 Property Address: �U� 1.2 Assessors Map& Parcel Numbers `r 6 11ov✓�Cw L la Is this an accepted street?yes Y no Map Number Parcel Number 1.3 'Zoning Information: 1.4 Property Dimensions: Zoning District Proposed Use Lot Area(sq It) Frontage(II) 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: Zone: _ Outside Flood Zone? Municipal❑ On site disposal system ❑ Public i$% Private❑ Check if yesE3 SECTION 2: PROPERTY OWNERSHIP!` 2.1 Ownert or Record: S�Fi'N EaJ Cyr.r+.r A+&'3 s 9LEH+ N-r/a O/ 9 O t��1me(Print) City,State,ZIP ay/ -hmlo* 39 � No.and Street Telephone 8mai1 Address SECTION 3: DESCRIPTION OF PROPOSED WORW(check all that apply) New Construction❑ Existing Building❑ Owner-Occupied ❑ 1 Repairs(s) ❑ Alteration(s) ❑ 1 Addition ❑ Demolition ❑ Accessory Bldg.❑ Number of Units_ I Other ❑ Specify: Brief Description of Proposed Work': alJ£r.> 13 u� llaom2N a .-rl I,Lrst6ir k_rfr.Hze AJs -- Il^iHrzan.•s ✓Le Ile-ae_A u. SECTION 4: ESTIMATED CONSTRUCTION COSTS Estimated Costs: Official Use Only I tell) Labor and Materials) S © I• Building Permit Fee:S Indicate how fee is determined: I. Building v ❑Standard City/Town Application Fee 2. Electrical S 0,00,042 ❑Total Project Costa(item 6)x multiplier x }, plumbing S ` 0,o o, 2. Other Fees: .S d.Mcclvanical (11VAC) S�j OC7c7. List: i 5. Mechanical (Fire S Total All Fees:S Suppression) Check No._Check Amount: Cash Amount:_ 6.Total Project Cust: S 76 U&w col ❑Paid in Full ❑Outstanding Balance Due: z4l 1jo N\Nu_EEV ll �1 SECTION 5: CONSTRUCTION SERVICES 5.1 Construction Supervisor License(CSL) CS -e0 y 3 5 f 60S j./Eti 0 License Number Expiration Date Name of CSL flulder list CSL"type(see below) /'N,9,12,r�t,k4Sy -Type -- Description No.,rod Street Unrestricted(Buildingsno to 35,000 cu. 11. S� e,.r Pvi R - C9 / 9 7Q Restricted I&2 FamilyDwelling City/('uvvn,State,ZIP M Masonry RC Rooting Covering WS Window and Siding 1 SF Solid Fuel Bruning Appliances Q399 f insulation Tele hmm F Email address D Demolition 5.2 Registered Home Improvement Contractor(HIC) HIC Registration Number Expiration Date IIIC Company Name or HIC Registrant Name 3 >e No.and Street Email address City/Town, State ZIP Tele hone SY. SECTION 6:WORKERS'COMPENSATION INSURANCE AFFIDAVIT(M.G.L.c. In.§ 2$C(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 ls§uance of the building permit. Signed Affidavit Attached? Yes ..........❑ No...........Cl SECTION 7a:OWNER AUTHORIZATIONTO EIKCOMPLETED W HEN. OWNER'S AGENT OR CONTRACTOR APPLIES FOR BUILDING.PERMIT 1,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 Narne(Electronic Signature) Date SECTION 7b:OWNEW OR AUTHORIZED AGENT DECLARATION By entering my name below,) 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. /! 3-/4, Print vner's or Authorized Agerfs Ntlme(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 not have access to the arbitration program or guaranty fund under M.G.L.c. 142A.Other important information on the HIC Program can be found at %vww.nmss.l,,ov'oca Information on the Construction Supervisor License can be found at AAAAjjas� 2. When substantial work is planned,provide the information below: 'total floor area(sq. R.) (including garage, finished basementtattics,decks or porch) Gross living area(sq. tl.) Habitable room cony Number of fireplaces Number of bedrooms Number of bathrooms Number of half/baths Type of heating system Number of decks/porches rypeofcoolingsystem Enclosed Open 3. "total Project Square Footage"may be substituted for"final Project Cost" y ittnEIMDBreaarorr 12D7v� . �I t S//I�fCpp6I,v3�Wjt AA1 $AOMBRiFYDL Feb 7�498�6 MAYCt Z�tnrdsSr.Pe DMBcxncrPUWPxMtmm4nnm=axen=aw Construction Debris Disposo►/Af}rdavit (required forall demolition andrenovation worky in acwrdam with the sbA edition of the State BuUd W Code, Tim CANL Secdon ills Debra& and the pr&*bns of MGL oW,S 54; &dJ ft Permit is Issued with the condign that the debris rewltft from this Work shelf be disposed of in a properly ketsed waste depm t Wity as defined by MGL c ill,S 15k The debris will be transported by: (name of hauler) The debris wi11 be disposed of In: r3 ram, • (name of fadlity) (address of facility) ignature of a 11cant Date