11 DUNLAP ST - BUILDING INSPECTION JACKET �3-7 � _V Q
�5 CRS H
The Commonwealth of Massachusetts 1kL
k IN5 ' CITY OF
Board of Building Regulations and Standards p�,t. hrU�a
/ Massachusetts State Building Code, 780 CMR t 4 QCZ �vi.�'ed.1 i,?01/
Q 4 Building Permit Application To Construct, Repair, Renovate Or Detwovish a
One-or Two-Family Dwelling
This Section For Official se Only
Building Permit Number: Date. plied: p
` Building Official(Pont Name). Signature Date
SECTION 1:311 E INFORMATION'
I.1 P op ty Ad ress: 1.2 Assessors Map& Parcel Numbers
��cr_0 S Sr. I12M, m
I 1 a Is this an accepted street?yes_✓ no Mop Number Parcel Number
1.3 Zoning Information: 1.4 Property Dimensions:
Zoning District Proposed Use Lot Arcs(sy It) Frontage(It)
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: t.8 Sewage Disposal System:
Zone: _ Outside Flood Zone? Municipal ❑ On site disposal system ❑
Public❑ Private❑ Check if yes13
SECTION 2: PROPERTY OWNERSHIV
2.1 OwnertofRecor NA�� ��p/ 50. IPirt M � D�Q7�
I rr ien.AP � SCn f-7 �tG2—
bltl1ne(Print) City,State,ZIP
�61 S ��ea >� 7 X 7R -766-�I7 1 r I LAl/f�a�/tczQComCri�.�T No. v,d Street T 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 BIJg.❑ Number of Units_ Other ❑ Specify:
Brief Description of Proposed Work-: 'e
SECTION 4: ESTIMATED CONSTRUCTION COSTS
Item Estimated Costs: Ofl7cial Use Only
Labor and Materials)
I. Building S 4 p 1. Building Permit Fee:$ Indicate how fee is determined:
❑Standard City/Town Application Fee
2. Electrical S ❑Total Project Costs(Item 6)x multiplier x
3. Plumbing S 2'r Other Fees: S
d. Mechanical (FIVAQ S List:
5. :Mechanird (Fire S Total All Fees:S
Su ression)
Check No. Check Amount: Cash Amount:
X 6. Total Project Cost: S ❑Paid in Full ❑Outstanding Balance Due:
�Jt✓—N T t O (jjb
SECTION 5: CONSTRUCTION SERVICES
5 1 -Construction Supervisor License(CSL) a
License Number EspimtionDate
-
Name of CSL Holder
List CSL'rype(see below)
Type- Description
No. ;md Street
U Unrestricted Ouildin s tie to 35,000 cu. It.
R Resuicted !&2 F:unil Dwellin
Cityfrown,State,-ZIP tivt Masonry
RC Rooting Covering
WS Window and Siding
SF Solid Fuel Burning Appliances
I Insulation
Telephone Entail address D Demolition
5.2 Registered Home Improvement Contractor(HIC)
HIC Registration Number Expiration Date
HIC Company Name or HIC Registrant Name
No. and Street Email address
City/Town,State ZIP Telephone
SECTION 6:WORKERS'COMPENSATION INSURANCE AFFIDAVIT(M.G.L.c. 15L§ 2SC(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 Ishuance of the building permit.
Signed Affidavit Attached? Yes .......... ❑ No........... ❑
SECTION 79:OWNER AUTHORIZATION:TO BE COMPLETED.WHEN
OWNER'S AGENT OR CONTRACTOR APPLIES FOR BUILDING PERMIT`
I,as Owner of the subject property,hereby authorize
tg act on my behalf,in all matters relative to work authorized by this building permit application.
Print Owner's Name(Electronic Signature) Date
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 application is true
and accurate to the best of my knowledge and understanding.
Date
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 riot have access to the arbitration
program or guaranty fund under I.G.L.c. I42A.Other important information on the H[C Program can be found at
wvvw.mass. goy v'oen Information on the Construction Supervisor License can be found at wtruv.mas.rzov:'d t�s
2. When substantial work is planned,provide the information below:
'total floor area(sq. R.) ,(including garage, finished basement/attics,decks or porch)
Gross living area(sq. tt.) 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 cooting system Enclosed Open_
3. "total Project Square Footage"may be substituted fur"Total Project Cost"
LOAN # 6841850727
DISCLOSURE OF SERVICING FEE SCHEDULE
PLEASE RETAIN THIS INFORMATION FOR FUTURE REFERENCE
Generally, there are no borrower-paid fees associated with the routine servicing of your mortgage loan. However, you
may occasionally find it necessary to request special services for which there is a charge. Listed below are some of the
fees that Bank of America charges for services that fall outside of the normal services provided:
MORTGAGE INSPECTION
BAY STATE SURVEYING ASSOCIATES INC. JOB#
100 CUMMINGS CENTER, SUITE#316J, BEVERLY,MA., 01915
�a NOTES
LOCATION :..' �^!=^�r!•t-•• �d!......•••••• 1)This is a mortgage inspection survey and not an
instrument survey,therefore this plot plan is for
SCALE : 1" =3o DATE :..... '3.r^'� ` mortgage inspection purposes only.It Is NOT to
••"•••••"••• be used to establish boundaries or for the
�yy ZS.S34- /OG-.S-4.S construction of any type of improvements.
REFERENCE : .: 1.:. ......•••••••••••. 2)This survey is based on survey marks of others.
.y. .......
arc/•,,,s'�;,,,Q,•�5 ...,... 3)Bushes,shrubs,fences and tree lines do not
• •• •••• necessarily indicate property lines.
..................................................
4)Whenever an offset Is 1'+.or less,an instrument
NK ��" �� it/ �ti survey Is recommended to determine property
TO: Ilnes,and any possible encroachments.
The location of the building(s)as shown,either, 5)Offsets shown are approximate,and are to be
complied with the local zoning setbacks at the time.of used-odtgfoc the-determination of zoning,Not to
construction or is exempt from violation enforcement be used-to establish properly Fines: -
action under Mass.G.L.Title VII Chapter 40A Section 7 6)In my professional opinion the building(s)are not
located in the special flood hazard zone,as
defined by H.U.D.MAP#
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��[,.,� / S + I TH X SEAL IS NOT
.THE PLAN IS A COPY
SHOULD sE ASSUMED TO
CONTAIN UNAUTHORIZED ALTERATIONS.
THE CERTIFICATION CONTAINED ON
THIS DOCUMENT SHALL NOT APPLY
TO COPIES.