34 CEDARCREST AVE - BUILDING PERMIT APP The Commonwealth of Massachusetts
Board of Building Regulations and Standards CITY OF
% Massachusetts State Building Code,780 CMR SALEM dMar
Revised Mar ZOII
Building Permit Application To Construct,Repair,Renovate Or Demolish a
One-or Two-Family Dwelling
This Section For Official Use Only
Building Permit Number: Date Applie . _r
Building Official(Print Name) Signature Date
SECTION 1:SITE INFORMATIO
1.1 Property Ad , : _ n ,�-{— 1.2 Assessors Map&Parcel Numbers
( 1
1.1 a Is this an accepted street?yes no Map Number Parcel Number
1.3 Zoning Information: 1.4 Property Dimensions:
Zoning District Proposed Use Lot Area(sq ft) Frontage(ft)
1.5 Building Setbacks(ft)
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:
Zone: _ Outside Flood Zone?
Public El Private❑ Check if yes❑ Municipal❑ On site disposal system ❑
SECTION 2: PROPERTY OWNERSHIP'
2.1 Owner of ec rd: a1�
Name(Print) City,State,ZIP
No.and tree Telephone Email Address
SECTION 3:DESCRIPTION OF PROPOSED WORK2(check all at apply)
New Construction❑ Existing Building❑ Owner-Occupied ❑ 1 Repairs(s) Alteration(s) ❑ Addition ❑
Demolition ❑ Accessory Bldg.❑ Number of Units_ Other ify:
Brief Description of Proposed Workz:
SECTION 4:ESTIMATED ONStRUCITON COSTS
Item Estimated Costs: Official Use Only
(Labor and Materials
1.Building $ I. Building Permit Fee:$ ndicate how fee is determined:
2.Electrical $ ❑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 S $ Total All Fees:$
Suppression)
Check No. Check Amount: Cash Amount:
6.Total Project Cost: 1
I 0 Paid in Full 0 Outstanding Balance Due:
SECTION 5: CONSTRUCTION SERVICES
5.1 Construed u ervis r is nse(CS )
License Number ExZn Hate
Name of CSL Hold
List CSL Type(see below)
No.and Sr1reet Type Description
U Unrestricted(Buildings up to 35,000 cu.ft.
R Restricted 1&2 Family Dwelling
City/fown,State, M Masonry
RC Roofing Covering
WS Window and Siding
Rhone
SF Solid Fuel Burning Appliances
(BLS/[)(( I Insulation
Tel hone Email address D Demolition
5.2 Registered Honlplim1wovem nt Con ctoi C)
O _
HIC egistratron Number *tDt,
MC p "e7e ame 11
No.and Email address
i
-city/Town,State,Z 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,pe 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
to act on my behalf,in all matters relative to work authorized by this building permit application.
Print Owner's Name(Electronic Signature) ate
SECTION 7b:OWNER[OR AUTHORIZED AGENT DECLARATION
By entering my name below,I hereby attest unde the airs and penalties of perjury that all of the information
contained inthis applicatioD is true and accurat to be of knowledge and understanding.
Print Owner s or Au orize Agent's ectr nic gna ure) to
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 die HIC Program can be found at
Information on the Construction Supervisor License can be found at
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"