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20 CHESTNUT ST - BUILDING PERMIT APP The Commonwealth of Massachusetts CITY . q 1 Board of Building Regulations and Standards OF SALEM PIYBl Massachusetts State Building Code,780 CMR,7'edition Revised January' . I i Building Permit Application To Construct Repair,Renovate Or Demolish a I, 2008 One or Two-Family ellmg Clsls5� 9a ` OiQiely , Building PepnitrNumberat Signature EmldinB Cummissi, erl Iusl eti#n4f But d T e P 1.2 Assessors Map&Parcel Numbers 1.1 Property Ad s. � .� ' � 5 I I Is this an;accepted street?yes ✓no_ Map Number Parcel Number 1.3 Zoning Information: 1.4 Property Dimensions: Lot Area(sq ft) Frontage(R) Zoning District, Proposed Use - 1.5 Building Setbacks(ft) Rear Yard - ' Side Yards Front Yard Provided Required Provided Required Provided - Required _ .1.6 Water Supply:(M.G.L c.40,§54) 1.7 Flood Zone Information: 1.8 Sewage Disposal System: Zone:._ Outside Flood Zone? Municipal❑.On site disposal system ❑ Public❑ Private❑ Check if yesO SECTION�- PRO 1F11 ,O N RS13 P'' 2.1^owner'of Record: a� G Name(Print) Address for Service: �( � 7 0 K Telephone Signature - _ $) TION 'DEACTtiP IOL�i` I �1 >i)f;(chccl-all thak apptyl 11, . New Construction❑ Existing Building❑ Owner Occupied ❑ Repairs(s) ❑ Alteration(s) ❑ Addition ❑ Demolition , ❑ Accessory Bldg. ❑' Number of Units_ Other ❑ Specify: Brief Description of ProposedWork2 t v � 00 SECTION 4:ESP IYIA ,COEIS�RU! TION' ,STS, Estimated Costs: Official Use Only - Item Labor and Materials ` 1 Butl`pmg PermitFoe $ I Indicate how fee is determined: I.Building $ ❑rgtantlard C1tyXlown Application Fee 2.Electrical - $ F] lotislroleuCoaT (Ram 6)•r{�nuattpliet' x 3.Plumbing C $ 4,Mechanical (HYA ) ,� , ,a,+r "- $.Mechanical (Fire $ otallFes, _ Su cession k Amount: Cash Amount: r � Ofteck�To �C�gc 6.Total Project Cost: $ J O+U ❑Patd'inFull `. :❑Outstanding Balance Due:._. sECTYax s b vs ?Ia 'si itufc�s 5.1 Licensed Construction Supervisor(CSL) —� /4f;7 MI ' > e L License Number Expiration Date Name of CSL-Holder List CSL Type(see below) (/ /ti( PVII iyUycl /a U P S ,?r agog Dbni'tion. Address {'+ U Unrestricted u to 35,000 Cu.Ft. / R Restricted 1&2 VAmily Dwelling Signature M Maso Onl F g3 3 RC Residential Roofing Covering Telephone WS. Residential Window and Sidin SF Residential Solid Fuel mining Appliance Installation D Residential Demolition 5.2 Re istere H e I provement Contrast nrc) 4� ti HIC Cotppen Name or C Reg' t tt a Registration Number c� a AddressExpiration Date - f Signature Telephone SECTIONb WORC{ERS'CpIII$ENSAT3ON 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 ❑ STIPN7a.JSNEIJTI©, - ApIOCi�s BE C14LU IIWREN� ;.r (1R NEIt'S A EN1 OR CONR/ITOR'A1? :t I3 F O1ZC f1I1 IIy P1 RMTI. - 1 1 Y ` /� as Owner of the subject property hereby authorize �.�c�_� to act on my behalf,in all matters relative to work authorized by this building permit application. Si nature of Owner - Date as Owner or Authorized Agent hereby declare that the statements and land nfotmatiotr on the foregoing application are true and accurate,to the best of my knowledge and behalf c, l Print Name �^ s 10,14, � Signature of Owner or Authorized Aggro Date Si ned under the pains and penalties of pe u 1.y 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 and Construction Supervisor Licensing(CSL)can be found in 780 CMR Regulations 110.R6 and 110.R5,respectively. 2. When substantial work is planned,provide the information below: Total floors 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"