66 BEAVER ST - BPA-14-1950 DEMO/REBUILD GARAGE Ck-
The Commonwealth of Massachusetts CITY OF
Board of Building Regulations and Standards SALEM
Massachusetts State Building Code, 780 CMR Revised dlur 2011
Building Permit Application To Construct, Repair, Renovate Or Demolish a
One-or Two-Fmndy Dtvelling
This Section For Official Use only
Building Permit Number. Dat plied
Building Official(Print Name). Signature - . . /a Date /
SECTION 1:SITE INFOILNIATIOW
1.1 Property Address: 1.1 Assessors Map&Parcel Numbers
66 a �r S�
Lin Is this an accepted street?yes no Map Number Parcel Number
1.3 'Zoning Information: 1.4 Property Dimensions:
"51.6Wnter
istrict Proposed Use Lot Area(sq R) Frontage(it)
Building Setbacks
Front Yard - - Side Yams Rear Yard
red Provided Required Provided Required Provided
Supply:(h1.G.L c.de,§54) 1.7 Flood Zone Information: 1.8 Sewage Disposal System:
Public❑ Private❑ Zone: _ Outside Flood Zone? Municipal ❑ On site disposal system ❑
Check if es❑
SECTION2: PROPERTY OWNERSHIP!
2.1 Owner'of Resrd: �� /� �R
Caro/ �. J�.�:g�� re
Nt1me(Print) City,State,ZIP
6'6 4 „Pr- 5>(
No.andNo.atd Street Telephone Email Address
SECTION 3:DESCRIPT)ON OF PROPOSED WORK'(check all that apply)
New Construction❑ZExisting Building Owner-Occupied ❑ Repairs(s) ❑ I Alteration(s) ❑ Addition ❑
Demolition Accessory Bldg.❑ Number of Units_ Other ❑ Specify:
Brief Description of Proposed Work' dokd6'
SECTION 4: ESTIhIATED CONSTRUCTION COSTS
11cm Estimated Costs: Official Use Only
Labor and Nlateriais -
1. Building S `// �/ 1. Building Permit Fee:S Indicate how fee is determined:
❑Standard City/Town Application Fee
2. Electrical S / 000 Q7 ❑Total Project Cost"(item 6)x multiplier x
3. Plumbing S �,Q1hcr Fees: S
4. Mechanical (FIVAC) S - - List:
E
chanical (Fire Total All Fees:S
essiun)
nCheck No. Check r\mount: Cash Amount:
Bll Project Cost: S ya /a�7 di] ❑ Paid in Full ❑Oulstanding Balance Due:
y3
y
SECTION 5: CONSTRUCTION SERVICES
5.1 Construction Supervisor/License(CSL)
� 0An E �CTPrS'O✓J License Number Expiration Date
Name of CSL[folder SLT a see below
List C ' YP ( )
/�lor t G ODescription Type - .
No.and Street
n�1 / U Unrestricted'DuilJin s u to 35,000 cu. If.)
LG ,11 �/7, �r �0 y R Restricted 1&2 F;unil Dwelling
Ci /rown,State,ZIP M Masonry
RC Roolin Coverin
WS Window and Sidin
SF Solid Fuel Burning Appliances
' 1-F2 tUs-lk y44a0, C--'7 1 Insulation
Tcle Kona t® Email uJJress U Demolition
5.2 R5kist/ered Home I/ngroovement Contractor(I11C)
/c/S o w HIC Registration Number Espvution Date
HIC Comp;my Nacre or 11jC Registrant Name ( /
S O roc d Q�� G'TCISG✓1 S�® hda. GM
No. and Street Email address
`rn rJSI-$9J' 88`tS
Ci own,State ZIP Telephone
SECTION 6:WORKERS'CONIPENSATION INSURANCE AFFIDAVIT(M.G.0 c. ISL§ 2$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 Issuance of the building permit.
Signed Affidavit Attached? Yes .......... No...........❑ b✓1 w� �/
SECTION 7a:OWNER AUTHORIZATION:TO BE CONIPLETED.)VHEN ."
OWNER'S AGENT OR CO NTRACCOR•APPLIES FOR BUILDING PERAIIT
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 Name(Electronic Signature) Date
SECTION 7b: OWNEW OR 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.
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(1-11C) 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
seww.nurss.ucn+'oca Information on the Construction Supervisor License can be found at wwsv.nrass.�ov'd,L .
r 2. When substantial work is planned,provide the information below:
'total floor area(sq. R.) �'� .(including garage, finished basement/attics,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
"rypeofcoolingsystem Enclosed Open
J. "Total Project Square Footagc"may be substituted for"rucrl Project Cost"
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