8A BUFFUM STREET EXT - BPA-15-90 f
RECEIVED
ss, The Commonwealth of Massach4INECTIONAL
Board of Building Regulations and Standards CITY OF
Massachusetts State Building Code,780.�"W 2b A � 20 SALEM
flit,, Revised Mar 2011
oBuilding Permit Application To Construct,Repair,Renovate Or Demolish a
�, One-or Two Family Dwelling
ILts Seehon Fot Offictat Jse-Ot4,
'nBuildmg Pemtt Number Date; plied:
l Building Offictal(Rmt Name) T" Signature Dare
`N`N/ii\JJ SECTION 1:SITE'DWORMATION
1.1 Property Address: 1.2 Assessors Map&Parcel Numbers
1— 8A BUFFUM STREET EXT
Lla Is this an accepted street?yes_ no Map Number Parcel Number
13 Zoning Information: IA Property Dimensions:
i
Zoning District Proposed Use Lot Area(sq fl) Frontage(ft)
1.5 Building Setbacks(ft)
.Front Yard Side Yards Rear Yard
Required Provided .Required FEovided Required Provided
1.6 Water Supply:(M.G.L c.40,§54) 1.7 Flood Zone Information: 1.8 Sewage Disposal System:
-
Publict Private❑ Zone' _ Outside Flood Zone?Check if yesgl Municipal fJ On site disposal system 0
SECTION 2: PROPERTY OWNERSHIP ,I
2.1 Owneri of Record:
AJAY NARANG SALEM, MA 01970
Name(Print) city,State,ZIP
8A BUFFUM STREET EXT 978-394-9477
No.and Street Telephone Email Address
SECTION 3.DESCRIPTION'0F PROPOSED WORIi t(check:A that apply)
New Construction❑ Existing Building IN Owner-Occupied ❑ Repairs(s) E3 I Alteration(s) ❑ Addition ❑
Demolition ❑ Accessory Bldg.❑ Number of Units 1 Other ❑ Specify:
Brief Description of Proposed WorL: REPAIR WURK
r y
SECTION 4:ESTIMATED CONSTRUCTION COSTS
Item Estimated Costs: Offielal Use Only
(Labor and Materials
1.Building $ HQ NJ n 1. Building Permit Fee:$ - Indicate how fee is determined:'
2.Electrical $ ❑Standard CttlbFown Application Fee
•❑Total Piolect Cost?(Item z multiplier , .. x
3.Plumbing $ 2 OtberFees. -
4.Mechanical (13VAC) $ Lam• • -
-5.Mechanical (Fire
Suppression)
$ Total All Fees.S
6.Total Project.Cost: $ lCQ 00
0
CheckNo;' Check Amount:.'" „CasliAmouht
1 ❑Pard"iu:Pull Outstanding Balance Due
C'p-(-t- -60rb 40
SECTION 5 CONSTRUCTION"SEYtVICES
5.1 Construction Supervisor License(CSL)
., Name of CSL Holder License Number Expiration Date
'
List CSL Type(see below)
No.sad Street "Type: Desctipuon
U Unrestricted(Buildings up to 35,000 cu.fL
Crtylrown,State,ZIP R Restricted 1&2 Family Dwelling
M Maso
RC Rooting;Covering
WS Window and Sidm
SF Solid Fuel Burning Appliances
i Insulation.
Telephone Email address D Demolition
5.2 Registered Home Improvement Contractor QUQ
HIC Registration Number Expiration Date.
HIC Compam+Naox m HIC Registrant Name
No.and Sleet
Email address
Ci /I o State,ZIP Tei hone
SECTION 6 WORKERS'COMPENSATION IN$URANCE.1ElwAYIT{M.G:I..c.I52.'§
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...........❑
- SECTION 7a:'OWNER AUTHORIZAI 1101141,1170B E'COMPLETED WHEN,
OWNER'S AGENT OR CONTRACTOR'APPLIESI?OR BUH.DING PERMIT-
1,as Owner of the subject property,hereby authorize
to act on my behalf,in all masers relative to u rk author by this building permit application.
Print Owner's Name(Electronic Signature) Date
"SECTION 7b:OWNERt OR AMOAM 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 accu tc to the b st of my knowledge and understanding:
AIAY NARANG
Print Owner's or Authorized AgenPs Name(ffiectr ntc 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(MC)Program),will pot 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/Mps
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.R.) 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'
Gmall -Signed document city of salem bldg applic permit- 1/26/15, 7:37 AM
a ! taritg cagy, *afag a gr.,ai! ;,,..
A
Signed document city of salem bldg applic permit-
Bob Bakst<BBakst@d rfix-it.net> Sat, Jan 24, 2015 at 12:00 PM
To: Ajay Narang <ajaynarang@gmail.com>
Cc: "ziad_ta@hotmail.com" <ziad_ta@hotmail.com>
Ajay,
Not a problem.
I will get a certificate of insurance for the property on Monday. Once I have that in hand I will go to the building
department to pull the permit. Once I have the permit in hand we can talk about the next steps required in order to
move the project forward.
Bob
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