3 BORDER ST - BPA-14-1405 SOLAR I ►3-1 - q05 c �� -7 9 igo
4 The Commonwealth of Massachusetts
Board of Building Regulations and Standards CITY OF
Massachusetts State Building Code, 780 CMR SALEM
Revised Mar 20l l
Building Permit Application To Construct,Repair,Renovate Or Demolish a
One-or Two-Family Dwelling
This Section For OfficJaIUse Only
Building Permit Number: Dat Applied:
Building Official(Print Name) Signature Date
SECTION 1: SITE INFORMATION
1.1 Property Address: 1.2 Assessors Map&Parcel Numbers
3 Border St 10 0102 0
l.l a Is this an accepted street?yes no Map Number Parcel Number
1.3 Zoning Information: 1.4 Property Dimensions:
RESIDENTIAL
Zoning District Proposed Use Lot Area(sq ft) Frontage(ft)
1.5 Building Setbacks(B)
Front Yard Side Yards 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 yes❑ -
SECTION 2: PROPERTY OWNERSHIP'
2.1 Owner'of Record:
Stephen Iwanicki SALEM,MA 01970
Name(Print) City,State,ZIP
3 Border St (978)744-7152 11mekeeper76@comcasLoet
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) ❑ 1 Alteration(s) ❑ I Addition ❑
Demolition ❑ Accessory Bldg. ❑ Number of Units I Other ❑ Specify:SOLAR PV
Brief Description of Proposed Work':INSTALL SOLAR ELECTRIC PANELS ON ROOF OF EXISTING HOME TO BE INTERCONNECTED WITH
HOMES ELECTRICAL SYSTEM.
SECTION 4: ESTIMATED CONSTRUCTION COSTS
Item Estimated Costs: Official Use Only
Labor and Materials
1.Building $8,000 1. Building Permit Fee: $ Indicate how fee is determined:
2.Electrical $17,000 ❑ Standard City/Town Application Fee
❑Total Project Cost'(Item 6)x multiplier x
3. Plumbing $ 2. Other Fees: $
4.Mechanical (HVAC) $ List:
5. Mechanical (Fire $
Su ression Total All Fees: $
Check No. Check Amount: Cash Amount:
L. Total Project Cost: $2j r 000 0 paid in Full 0 Outstanding Balance Due:
Y SECTION 5: CONSTRUCTION SERVICES
5.1 Construction Supervisor License(CSL)
107663 8/29/2017
SOLARCITY CORP./CRAIG ELLS License Number Expiration Date
Name of CSL Holder
List CSL Type(see below) D
24 ST MARTIN DRIVE BLD 2 UNIT 11
No.and Street Type Description
MARLBOROUGH,MA01752 U Unrestricted(Buildings u to 35,000 cu.ft.
R Restricted 1&2 Family Dwelling
City/Town,State,ZIP M Mason
ry
RC Roofing Covering
WS Window and Siding
SF Solid Fuel Burning Appliances
978-875-1698 CELLS@SOLARCITY.COM I Insulation
Telephone Email address D Demolition
5.2 Registered Home Improvement Contractor(HIC) 168572 3/8/2015
SOLARCITY CORP. - HIC Registration Number Expiration Date
HIC Company Name or HIC Registrant Name
800 Research or ablanm@solarcity.com
No.and Street
Email address
WlmingWn Ma.01887 617-417-7312 '
City/Town,State,ZIP Telephone
SECTION 6: WORKERS' COMPENSATION INSURANCE AFFIDAVIT(M.G.L.c. 152. § 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 Issuan a of the building permit.
Signed Affidavit Attached? Yes .......... No........... ❑
SECTION 7a: OWNER AUTHORIZATION TO BE COMPLETED WHEN
OWNER'S AGENT OR CONTRACTOR APPLIES FOR BUILDING PERMIT
I,as Owner of the subject property,hereby authorize solarcity
to act on my behalf, in all matters relative to work authorized by this building permit application.
; See eonl(L2C{ 8/22/2014
Pnnt Owner's Name(Electronic Signature) Date
SECTION 7b: OWNER' 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[Miss application is true Jand accurate to the best of my knowledge and understanding.
CIS 1�(A 4")lUnCo D 6/22/2014
Print Owner's or Authorized.Agent's Name(Electronic Signature) Date
NOTES:
1. 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
www.mass. ov/oca Information on the Construction Supervisor License can be found at www.mass.gov/dps .
2. When substantial work is planned,provide the information below:
Total floor area(sq. ft.) (including garage,finished basement/attics,decks or porch)
Gross living area(sq. ft.) 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"Total Project Cost"
M
1
CITY OF SMXM, 2UNSSACHUSETTS
BuMDLNG DEPARTMENT
130 WASHNGTON STREET,3' FLOOR
TRL (978) 745-9595
FAX(978) 740-9846
KI\iBERLEY DRISCOLL
MAYOR THomAs ST.PIEARH
DIRECTOR OF mmic PROPERTY/BU DING COMMISSIONER
Construction Debris Disposal Affidavit
(required for all demolition and renovation work)
In accordance with the sixth edition of the State Building Code, 780 CMR section 111.5
Debris, and the provisions of MGL c 40,S 54;
Building Permit# is issued with the condition that the debris resulting from
this work shall be disposed of in a properly licensed waste disposal facility as defined by MGL c
111, S 150A.
The debris will betransported by:
(n a of hauler)
The debris will be disposed of in :
Y1` �rY1�S�e� @ S6larci f4 wi I v��i ttcr rUY�
(name of facility) T
sCC) &sc-etrcdl lac . 0)'Imw>4,kO MG. oI ���
(address of facility)
signature of permit applicant
date
debrimtfdue