7-9 CHERRY ST - BUILDING PERMIT APP (002) ^a
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The Commonwealth of Massachusetts
� Board of Building Regulations and Standards CITY OF
Ali� Massachusetts State Building Code, 730 CMR SALEM
i
Building Permit Application To Construct, Repair, Renovate Or Demolish a Revised,tlar20ll
One-or Two-Family Divelling
This Section For Ott cial Use Only
Building Permit Number:
Date.Ap ied:
Building OtTicial(Print Name). '"�
Signa re �', Dat
SECTION 1:SITE INFORiMIA I]ON
1.1 Pro ert ddress•Y ('�� 1.2 Assessors Map& Parcel Numbers
L l a Is this an accepted street?yes_ no_ Map Number
1.3 'Zoning Information: Parcel Number
I.J Property Dimensions:
Zoning District Proposed U,,
Lot Area(sy R) Frontage(It)
1.5 Quilling Setbacks(ft)
Front Yard Site Yams
Provided Re
Required Provided Rear Yard
Required Require Provided
1.6 Water Supply:(M.O.L c.40,§54) 1.7 Flood Zone Information:
Public❑ Private❑ Zone: _ Outside Flood Zone? 1.3 Sewage Disposal system:
Check ifyes❑ Municipal❑ On site disposal system ❑
SECTION2.- PROPERTY OWNERSHIP'
2.l�vncrt of Rccor
�l U�y
Nth nc(I(r��mt)
� 1 � LIC.nC CitY,State,ZlP Q
$�tti Nc.zar tee ys�+. .w
Telephone Email Address
SECTION 3: DESCRIPT)[ON OF PROPOSED WORK'(check all that apply)
New Construction❑ Existing Building W Owner-Occupied ❑ Repairs(s) ❑ Alteration(s) ❑ Addition CI
❑ Accessory Bldg.❑ Number of Units
Brief scription of Proposed Work-: Other ❑ Specify:,
Uf UHa 3=
SECTION 4: ESTIMATED CONSTRUCTION COSTS
Itcm Estimated Costs:
Labor and Materials Official Use Only
I. Building $ I. Building Permit Fee:$ Indicate how fee is determined:
2. Electrical S ❑Standard City/Town Application Fee
3. Plumbing ❑Total Project Cost"(Item 6)x multiplier s
2. Other Fees: S
4. `fcchanical (1-IVAC) S List:
5. Mechanical (Fire
Su rcssion) S Total All Fees:S
6. 'rotal Project Cost: $ Check No._Chet-- .k;�mowit Cash Amount:_
❑Paid in Full ❑Outstanding Balance Due:
SECTION 5: CONSTRUCTION SERVICES
5.1 Construction Supervisor License(CSL) _ �II CS-69 Ee Expiration Da�
C�- 0 8`�'f �b �YIMBnd Borah��1 License Number P
Name of CSL ftolder List CSL'fype(see below)
�a,L rolmd a ('s — Type _ Description.
No.❑nd S ect /„ U Unrestricted(Buildin s u to 35,000 cu. 11)
��/os., /(_ S R Restricted 1&2 Fnni1 Dwellin
177 q Mason
City/town,State,"LIP OC 7 7 7� RC do Covering
(� 1V5 Window and Sidin
*TmaE9 SF Solid Fuel Burning Appliances
-7d l d!!1� RBJanlsag Can I Insulation
e [7 F l D Demolition
.— —' Email address
Tole hone _
5.2 Registered Home Improvement Contractor(HIC) IIIC Regis r Expira
f IIC Company Name or HIC Registrant Name
Email address
No,and Street —_
Tele hone -.
City/Town,State,ZIP
SECTION 6:WORKERS'CONIPENSATION 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 7a:OWNER AUTHORIZATION TO BE COMPLETED WHM
OWNER'S AGENT OR CONTRACTOR APPLIES FORBUI ING PERMIT
f
I,as Owner of the subject property,hereby authorize
t9 act on my behalf,in all matters relative to work authorized by this building permit applic; 1
.u<3 1� pc —Pr N� ate
Print owner's Na ne(Electronic Signature)
SECTION 7b:OWNERt OR AUTHORIZED AGENT DECLARATION
perjury that all of By entering my name below,I he s true andattest
under
the best pains
of my knowledge and understanding.
information
the ge
rate
contained in this application
Date
Print owner's or r\utlwrized Agcnt's N:une(Electronic Signature)
NOTES:
I. An Owner who obtains a building permit to do his/her own work,or an`olln'rt`hava access toires an ttthe arbitratioregistered n
(not registered in the Home Improvement Contractor(HIC)Pro ram),
program or guaranty fund under vLG.L.c. Id2A.Other important information on the FI(C Program can be found at
programos,��ovrant information union on the Construction Supervisor License can be found at www.mass."o.�y!`IL
�. When substantial work is planned,provide the infor m tion bie ow:garage,finished basement/atlics,decks or porch)
incTotal tloor area(sq. ft.) Habitable room count
Gross living area(sq. It.) Number of bedrooms
Number of fireplaces Number of half/baths
Number of bathrooms Number of decks/porches Type of heating system�-- Enclosed___Open '.
Type of cooling system
3. "Total Project Square Footage"may be substituted for Total Project Cost"