5 DUNLAP ST - BUILDING PERMIT APP JACKET O CSYl 2�c�1' 4 333`7 1
N The Commonwealth of Massachusetts — ' ,( j \Cttf OF
Board of Building Regulations and Standards SALEM
y Massachusetts State Building Code, 780 CIVIR 1016 DEC -8 eAtedS,( rr 20l/
Building Permit Application To Construct, Repair, Renovate Or Demolish a
One-or Tivo-Family Dwelling
This Section For Official Use Only
77 Building Permit Number: Date Applied:
VZBuilding miicial(Print Name). Signature - , Date
SECTION t:SITE INFORMATION'
1.1 Property Address: 1.2 Assessors Map&Parcel Numbers
fi7 Q4,Azi-A e SM
1.la 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(sy R) Frontage(11)
1.5 Building Setbacks(it)
Front Yard Side Yards Rear Yard
ReyuircJ Provided Required Provided Required Provided
1.6 Water Supply:(M.G.L c.40,§54) 1.7 Flood Zone Information: 1.8 Sewage/Deposal System:
Zone: _ Outside Flood Zone? Munici of;On site disposal system Cl
Public I" Private❑ Check If es❑ P po y
SECTION 2: PROPERTY OWNERSHIP!'
2.1 Ownert of Record: SG\( ,r,, NA , O t 7Y�
_�r•r n r 1' t
�1N me(Print) City,State,ZIP
-96
No.anJStreet a 09 Email Address
SECTION 3: DESCRIPTION OF PROPOSED'WORW(check all that apply)
New Construction❑TExisttng Building Owner-Occupied ❑ Repairs(s) Alterntion(s) ❑ I Addition ❑
Demolition ❑ Accessory Bldg.❑ Number of Units_ Other ❑ Specify:
Brief Description of Proposed Work=: 2 5 —^ T t
p n�
SECTION 4: ESTIMATED CONSTRUCTION COSTS
Estimated Costs: Official Use Only
Item Labor and Materials)
I. Building � I. Building Permit Fire:$ Indicate how fee is determined:
❑Standard Cityfrown Application Fee
2. Electrical i ❑Total Project Cost'(Item 6)x multiplier x
3. Plumbing S ZOC> 2. Other Fees: S
4.Mcchmlical (FIVAC) S List:
5.Alechanicai (Fire S 'total All Fees:S
Suppression)
Check No._Check Amount: Cash Amount:_
6.Told Project Cost: S 7 d 0-0,.Gz- 0 Paid in Full ❑Outstanding Balance Due:
12I I LA M A i t_1=17 T73
SECTION5: CONSTRUCTION SERVICES
5.1
�Coustruction Supervisor Liccnse(CSL) ��l2� h'
'I 1�,�� e,✓r ' r �r„Qi�f- License Number E.epuution ate
;unc of CSL Holder
List CSL'fype(see below)
P, C7, P,O Y 'j 3 1-// /! T e Descr ption
No.and Street
U Unrestricted(Buildings Lip-to 35,000 cu. fl.
C L A •�� d M . , G7 Restricted 1&2 Family Dwelling
City/fown,State,ZIP M Masonry
RC Rooting Covering
WS Window and Sidinx
SF Solid Fuel Burning Appliances
1 Insulation
Tee hung Email address m D Demolition
5.2 Registered Home Improvement Contractor IIC) Hle /G V3,1-7
6 C L�6±E tee. 1 +�G1n d? C ' •Yv"a IIIC Registration Number xpt lion Dole
IIIC Company Name or IIIC gtgrstranl Name
P.o f��u; r�// / h'G// olG/ . 'JA:t., r✓ Grl �Arnr➢ L� •
No.and Street Email addre
City/Town, State ZIP' Telephone
SECTION 6:WORKERS'COMPENSATION INSURANCE AFFIDAVIT(M.G.L.c. 152.1 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...........I�-
SECTION 7a:OWNER AUTHO.RIZATION:TO BE COMPLETED WHEN" -
OWNEWS AGENT OR CONTRA CT ORAPPLIES FOR BUILDING PERMIT`
1,as Owner of the subject property,hereby authorize QZ ryr e P) 'e ( �,. rr-P/f ,+
t9 act on my behalf,in all matters relative to work authorized by this building permit application.
C r-i h TSt r,P M
Print Owner's Name(Electronic Signature) Date
SECTION 7b:OWNEW ORAUTHORIZED AGENT DECLARATION
By entering my name below, I hereby attest under a pains and penalties of perjury that all of the information
contained in this application is true and accurat he best of my knowledge and understanding.
j �
Print Owner's or Authorized Agent's ume(Ele me Signature) ate
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(HIC)Program),will Ligy have access to the arbitration
program or guaranty fund under NI.O.L.c. I42A.Other important information on the HIC Program can be found at
www .c.nmssuv'oca Information on the Construction Supervisor License can be found at hvww.nhass,"0v:'d11s
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. 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 ofcoolingsystem Enclosed Open
3. -Total Project Square Footage"may be substituted far"fatal Project Cost"
cK �f0
I'lie C'unnnonwcalth ul b1:u,aihuscus
s, ,� Ihmrd OI Building Regulations and Slandards CITY OF
Massachusetts State Building Cude. 780 CNIR ti,\Lli\I
L, .•
Building Permit Application To C'onsiruct• Repair. Renovate Or Demolish a
Onc-ur Tivn-f,Imd Dtrrllin•�
This Section Fur 01'flcia be Onl
liuilJing Permit Number: Date pplied:
Ilti lding 011lcial(Print Muriel Sitpmt Dale
SECTION I:SITE INFORAIA ON
1.1 r er•�r Address: / 1.2 Assessors Map Parcel Number
l�&&I—Ae .. -
I.In Is this an accepted street?yes no flap Number Purcel Number
1.3 Zoning Information: 1.4 Property Dlarenslons:
Luring District Proposed Ow Lot Arco(sy 11) Frontage(II)
1.5 Building Setbacks(B)
Frunt Yard Silo Yards Rear Yard
Re,luired Provided Reyuircd Provided Reyuircd Provided
1.6 1Yater Supply:(M.G.I.c. JU. §Ja) 1.7 Flood Zone Inform illont 1.8 Sewage Disposal System:
Public O Private O zone: _ Outside Flood Zone? Muniei d O dis sul On site s rlom O
Check if es0 P W >�
SECTION2: PROPERTYOWIYERSHIPt
N;une(Pmm) Uly.Smte.l.I1
No.and Street ele 0 Finail Address
SECTION!: DESCRIPTION OF PROPOSED WORK'(check all that apply)
New Construction E3 Existing Building O Owner-Occupied O Repairs(s) O Alteration(s) O Addition O
Demolition O Accessory BIdy. O Number ofUnin_ Other O .Specify:
Brief Description of Proposed Work': AlfJ "1
lc �yN1' n/Sve s�e 1
sT M
SECTION 4: ESTIMATED CONSTRUCTION COSTS
Itcnt Estimated Costs:
IL and..\laterials) Official Use Only
I. Building S I. Building Permit Fee: S Indicate how lice is determined:
'. HvI lrical S O Standard CityTuwn Applicmion Fee
'�� O Tuml Project Cost'i Item 6)x� mulli Iler _ _ x t7 ! I'lumhi°g S '. Other Fees: S P —
7 J. \Icchanical ill\ W) S List:
O Sii ,+nesioni S fatal \IIFces: S
Chcd Ni). :\imnml'
n Total I'rnjecl Cost: i So. a`l� - _—( hvck _. .._ . .Ce>h \m.nuu:
/ O P.tid in Full ❑Oulslanding Ilal.mcc Due: 1 ..LL
/S1A, �0 ( �atfrG� I0�
i
St:( I1(IN S: ('ONSI'Rll('rioN SERVICES J
4.1 ('unstrucliuu Sul isur License I('SL1 �.��G76
\ unc,ll'(S iloldcf �.�-- ilsll'SL I\pel,evhelanl__._S�__. .._
PC I)eiahrion
,Vu. end\I '•t II I hlre,aicteJ I Ilol IJinws tip to ty,Uotl\u. Il.l
%�� "— .� . _.__ it Ite,Inde Ll� I .m,J Dllcllill
Ci1)!fo„n,Shne.LII' .\) Mason
I(L' N,auin C'u,erin
µ'S µ'indim ald sidin
_ SF .Solid Paul lluming:\ppliances
I Insulation
lets bona
IOnail aJJrcs D Denutliliun
6.2 Registered IIunit Im1)ruv Melt l Contractor(II IC) /_ 4 9 11 it
S/J MFUA 1J CONS IIIC Itcgislration Nunlhcr F\piruliou Dula
I IIC•C,111pau) Name or I IIC Itegistrunl Name �--� _ //
Freud address
Nu, and Street
� �M4 �i7�t9sca7
City/Town. State ZIP rele one
SECTION 6:WORKERS'COMPENSATION INSURANCE AFFIDAVIT(M,G.L C. 152,1 25C(6))
Workers Compensation Insurance affidavit must be completed and submitted with this application. Failure to provide
this attldavit will result in the denial of the Iss ante of the building permit.
Signed AMdavit Attached? Yes ...... No ........... O
SECTION 70:OWNER AUTHORIZATION TO BE COISIPLETED WHEN
OWNER'S AGENT OR CONTRACTOR APPLIES FOR BUILDING PERMIT
1,as owner of the subject property,hereby authorize Lfi'r �0Y4 Ci S1uJ to act an my behalf,in all matters relative to work authorized by this building permit application.
s toData
Print Uwncr's Nulne(ElMMIllo Signature)
SECTION 7b: OWN ERI 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 appl
ication is true and accurate to the best of my knowledge and understanding.
T
Dal
unit 5i nawrol
Prim Uwncr'e ar:\uthorVeJ \�cnt's N;unu Ilaevtr a
VOTES:
7hensubsiantial
r who obtains a building pennit to do his.her Own work,or an owner who hires an unrcgisterd ntriour
w' nu have access to the arbitration
r d in the Hume Impruvrment Contractor 1 HICI Program),will�
registered , information on the HIC Program can be found at
•. I1..>. Other im unanl color
programor �uarant I'unJ under\LG.L. v P b Y I.I. .
auction Su enisor License can be found a
,. ;,�. � I Illfaf111;111Un an the Cons pstantial tsork is planned, pro%ide the information below:a I sy. Il.l _ ____.._1 including garage, linished basement atfics. Jerks or porch)
area 1 i . IL I 1labiiable room count ._ ..
\unlhcr of lircplaccs .. _._ \ulllbU ul hf - -
\ulnh¢r ofl,adln,ullld \umhcrofhalf h.1111i
po
\anther of Jccks porches �
I\11e o f 11c.16114 '),1011
I\pal l'aading ,\acln I wlo,cd _I)pan
1 "I, Idi l'fU1CCt ti,hl,lre r,l„Llge III;1.N1, 1,h,Idntpl liV',local i'rojeel(,1,t"