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3 1-2 BECKET AVE - BUILDING INSPECTION (2) � zwvi The C'unumunweallh of Massaehusells y; '� Board Of Building Regulations and Standards CITY OF 'r c, Massachu5Ctt5 State Building Code, 780 CNIR SALEM 'L•,� Revised tLtr-'11// Building Permit Application 'ro COI)SIrUct, Repair, Renovate Or Demolish a Ohre-or row-F2unih D,rel10{t, This Secliun For 01'flcial Us•.Onl +. _ C�1 _ Building Permit Number. Date;\p ied: /ft� � Dudding'011icial(Print N,une) Signature Dale -AAJS SECTION I:SITE INFOR51ATION I.,I Pr pert ddres: 1.2 Assessors blap& Parcel Numbers 1.1 a Is this an accepted street?yes no Map Numher Parcel Number 1.3 Zoning Information: 1.4 Property Dimensions: Tuning'District Fr,,p..ed(Ise Lot Area(sq It) Fmnluge(11) 1.5 Building Setbacks(R) Front Yard Side Yards Rear Yard Required Provided Required Provided Required Provided 1.6 Water Supply:(M.G.I.c. 40.§Sa) 1.7 Flood Zone Information: 1.8 Sewage Disposal System: Public❑ Private❑ Zone: _ Outside Flood Zone? Municipal❑ On site disposal Check if cs0 P system ❑ SECTION2: PROPERTY OWNERSHIP' 2.1 Ownerl of ecord: N;une tP , City.State.ZIP )�a ' (5170 ;Nu. nd Streel Tdeph m,e 6nail Address SECTION J: DESCRIPTION OF PROPO D VORKs(check all that apply) NewConstruction❑ Existing Buildin Osvner•Occupie Repairsts) ❑ 1 Alterationts) ❑ Addition ❑ Demolition ❑ Accessory Bldg.❑ 1 Number of Units Other ❑ .Specify Brief Description of Proposed Work-: UG G SECTION J: ESTIdIATED CONSTRUCTION COSTS Item Estimated Costs: (Lahurand.Materials) Oft NI use Only 1. Building $ I. Building Permit Fee: $ Indicate how fee is determined: 2. Electrical $ ❑Standard City/Town Application Fee ❑Total Project Cost'(Rent 6)x multiplier lier 1. Plumbing $ . Other Fees: $ 4. \Icch;mic,,I III\'.\('1 S List:_ 5. \lechanical (Fire .--_-- _-- —`— .--'— ___ 17f✓✓✓ tiu+rrcision)) S Total .\II Fees: $ n. Total Project CnsC �LO� Cheek No. _ _('heck:\mount: Cash \nwnl:u 5 ❑P;Iid in Full ❑Outstanding Balance Due: �� ab 06k frw SECTIONS: ( ONSTRUCrIOIN SFRVI(TS / 5.1 ConstructionSupenisorLiccnse(CSLI tot-95 S-'e dr -------2 - —' --- - - -- 1G1u1_n J1 .pl.t License Number Niir Lion Lik: Nuntc ol'l'SI. I loader n e J I ist('St. I)lie Laac hclu+ll._-__.—_ _— ------/------- ------'----- ------------ 1)pe Duieriplion No, anJ Street — A A © a j'�^�b U l In trice d 1 12 Family mn y a l0 13,U110 cu. ILI 1_, 1_'{ R RcstrictcJ I t? Pumil � Ilucllin Cit�i loan,.`talc LlP b1 blason NC Ittioling Covering ...—._ W'S Window;mdSiding 7Y �/ ,/p�r� /� p SF Solid Fuel Burning Appliances [i '��Y7/ /"/r7cu&Y (C'pf&r"ie' I Insulation I cic hone ['.mail address D Demolition 5.2 Registered Home I 1pruvemei t/Contracto (111Cp)� IIIC Registration Number Papir;uiun DWc I I ly,MM I IIC 12)rgi;tr• t1 N ale No, and Stmt /t A ,/(� P�M� oy/v Gyg-_�y/3N7 Email addresi Ci /Town,State,ZIP rcic hone SECTION 6:WORKERS'COMPENSATION INSURANCE AFFIDAVIT(M.G.L.c. 152. 1 25C(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........... O SECTION 7s:OWNER AUTHORIZATION TO BE COMPLETED WHEN OWNER'S AGENT OR CONTRACTOR APPLIES FOR BUILDING PERMIT I,as Owner of the subject property,hereby authorize �G l( /.1 4LJ r ' "p/ to act on my behalf,in all platters relative to work authorized by this building permit applic.Lion. 64J J l� glordoAold I 49 l4 l3 Print 0 rItner's Name(Electronic Signature) 7 Dd e SECTION 7b:OWNERt OR AUTHORIZED AGENT DECLARATION By entering my name below,I hereby attest under the pains and penalties of perjury that all of the information contai 1 this application is true and accurate to the best of my knowledge and understanding. Ll Print Uencr's or:\utlxxiicJ Agent's Nunn Ililuctrunic Signature) I atc NOTES: I. An Owner who obtains a building permit to do his.her own work,or an owner who hires an unregistered contractor I nut registered in the Home Improvement Contractor(HIC) Program),will nu have access to the arbitration program or guaranty fund under \I.G.L.c. I42A.Other important information on the HIC Program can be found at ao+1 m.n. L;o+ o.,i information on the Construction Supervisor License can be found at 2 When substantial lurk is planned,provide the information below: Total floor area Isq, R.1 - I including garage, finished basenlentauics,decks or porch i (boss living area I sq. 11.1 ._---- _ _.. . _ Habitable room count 1 \umber of7ircplaces _ Number of bedrooms - __.. ..-- —. .. . . iVmttlbef kit'bathrooms . . . _ -. \'unlbcrofhalfhMIN .. . . .. . i I%pcofheatingsystem Number o(decks, porches - I)Ile of 0101111g i1 itetll Fnclojed (ape❑ t, "l+a,d Project Square Pooutgc"play be iahititutcd hr"1'nt;d I'rojecl Cost-