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44 BUTLER ST - BPA-15-414 The Commonwealth of Massachusetts G 1 3(o 5 -7 0 = Q,a Board of Building Regulations and Standards CITY OF UY$ Massachusetts State Building Code,780 CMR SALEM Building Permit Application To Construct,Repair,Renoj Revised Mar 2011 One-or Two-Family Dwe}W'Fi$E CT 1 B This Section For Official Use Only uilding Permit Number: Date Appli {� Building Official ✓ �v'�''•'� cit„j ��r)' �-- (Print Name) Signature � SECTION 1:SITE INFORMATION Date 1.1 Property Address:' 1 NY %3J f l c'T S— S'r 1., 1•2 Assessors Map&Parcel Numbers 1.1 a Is this an accepted street?yes i/ no Map Number 1 1.3 Zoning Information; Parce]Number 1.4 Property Dimensions: Zoning District Proposed Use Lot Area(sq ft) Frontage(ft)F1.5 Building Setbacks(ft) Front Yard Side Yards Required Provided Rear Yard Required Provided Required Provided 1.6 Water Supply: (M.G.L c.40,§54) 1.7 Flood Zone Information: Public❑ Private❑ Zone: _ Outside Flood Zone? 1 8 Sewage Disposal System: SECTIO Check if yes❑ Municipal❑ On site disposal system ❑ N 2: PR 2.1 Owner'of Record: OPERTY OWNERSHIP' Name(PnnH N (� 7 A o I CtiN it e rs I v lr2Ty ]]T ,r M '� 0 i 9 2 3 No and Street A V e /_iL4^I S /Z Telephone Email Address SECTION 3:DESCRIPTION OF PROPOSED WORK=(check all that apply) New Construction❑ Existing Building❑ Owner-Occupied ❑ Repairs(s) ❑ Alteration(s) ❑ Addition ❑Demolition ❑ Accessory Bldg. ❑ Number of Units Brief Description of Proposed Aurkz: r Other ❑ Specify: -tv 'FQiJLie �� ,� rn� ; � r� ceic SECTION 4:ESTIMATED CONSTRUCTION COSTS Item Estimated Costs: Labor and Materials Official Use Only 1.Building $ I l 1. Building Permit Fee:$ Indicate how fee is determined: 2.Electrical $ ❑Standard City/Town Application Fee 3.Plumbing $ ❑Total Project Cost'(Item 6)x multiplier x 2. Other Fees: $ 4. Mechanical (HVAC) $ List: 5.Mechanical (Fire Su ression) Total All Fees:$ 6. Total Project Cost: $ C J Check No, Check Amount: Cash Amount: 0. U�� ) ❑Paid in Full ❑Outstanding Balance Due: �b slls t✓mor, y SECTION5: CONSTRUCTION SERVICES 5.1 Construction Supervisor License(CSL) Name of CSL Holder License Number Expiration Date Y/ 4 m b J'i List CSL Type(see below) No.and Street m Type Description • t © Z! Unrestricted(Puildings up to35,000 cu. ft. City/To ,State,ZIP R Restricted ]&2 Famil Dwellin M Maso D GL6au� RC Roofin Covering onstmct�- tion Super rsor s Signature or(Electronic Signature) WS Window and Siding 131 9 i/I ' -Z SF Solid Fuel Burning Appliances V — (� r �t Q' �7 gf 'i ,41 I Insulation Telephone Email addiess D Demolition 5.2 Registered Home Improvement Contractor(HIC) I r) 7 S tl/� i L n / G - HIC Company Name or BIC Registrant Name HI R istratio ber Expiration 110 t EJ min t s ,-ram 3 3 c No.and Street?tl tr I fnA 017/ ' !q 8 /6 9 Registrant's Signature Ly/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 Issuance of the building permit. Signed Affidavit Attached? Yes .......... - No...........❑ SECTION 71:1:OWNER AUTHORIZATION TO BE COMPLETED WHEN OWNER'S AGENT OR CONTRACTOR APPLIES FOR BUILDING PERMIT 1,as Owner of the subject property,hereby authorize J>PU' 0 )>4 CL Sc�'Vi( LG nuts �-Ai7n ,Lpacton my behalf,in all matters relative to work authorized by this building permit application. .SEE t9r/Au-4,e Owner's Signature or(Electronic Signature) Daze 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 applica ' n is true accurate to the best of my knowledge and understanding. wner's or orized Agent's Name or(Electronic Signature) ate NOTES: Owner who obtains a building permit to do his/her own work or an owner who hires an unregistered contractor(not riot have access to the arbitration program or registered in the Home Improvement Contractor(HIC)Program),will guaranty fund under M.G.L.c. 142A.Other important information on the HIC Program can be found at wrny.mass.govioca Information on the Construction Supervisor License can be found at www.ma_ ss_ gov/doc 2. When substantial work is planned,provide the information below: Total floor area(sq.ft.) (including garage,finished basementlattics,decks or porch Gross living area(sq. ft.) Habitable room count P ) Number of fireplaces Number of bedrooms Number of bathrooms Number of half/baths Type of heating system Number of decks/porches T e of coolie s stem Enclosed en 3. "Total Project Square Footage"may be substituted for"Total Project Cost" Ur r1r TlTrn Ar AT,rxrlTrl_ , rrL'Ar TU LT Un DrnAr nAC nr rrA. nT/_ _ AAAr MUXIAXTr V l 8 F +' ZZ +.i sir� `� .. �., � { '4■( � �� w R :4•F yv M�I�f ��lF 4 'lrv, Yl � a'° • ,'+`6q ,r ...ram'`- ,1Fx`� y� �i Y° yy�� w i Ef4 { Y .k >r �t ar t � a 31y 5i F Z, Ib r*; M� a i t "" Yt �W f '' m 1rF4e. 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