394 ESSEX ST - BUILDING PERMIT APP (002) C--r- 121E -3
The Commonwealth of Massachusetts
°uld Board of Building Regulations and Standards ` 4 ' aa`CITY OF
( Massachusetts State Building Code,780 CMR c " "� 1' L e M
Revise � a�r2'071
Building Permit Application To Construct,Repair,Renovate OrB�lrtolish I
One-or Two-Family Dwelling LL �100 PP UU YY P 12' 50
This Section For Ofoial Use Only
n Building Permit Number: Date. pplied:
Building Official(Print Name) - Signature - ro - -D
® SECTION 1:SITE ITIFORMATION
1.1 Property Address: .— U 3 1.2 Assessors Map&Parcel Numbers
r� L la Is this an accepted street?yes ✓no Map Number Parcel Number
1 1.3 Zoning Information: 1.4 Property Dimensions:
Zoning District Proposed Use Lot Area(sq R) Frontage(it)
1.5 Building Setbacks(ft)
From 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:
Public❑ Private❑ Zone: _ Outside Flood Zone? Municipal❑ On site disposal system ❑
Check if yes❑
SECTION 2: PROPERTYOWNERSHI"
2.1 Owner'of Record:
Name(Print) City,State,ZIP
35�f &5Sfzx C1- 3 0$Y• SS3 A150
No.and Street Telephone Email Address
SECTION 3:DESCRIPTION OF PROPOSED WORK(check all that apply)
New Construction❑ Existing Building❑ Owner-Occupied ❑ I Repairs(s),° Alteration(s) ❑ Addition ❑
Demolition ❑ Accessory Bldg.❑ Number of Units_ Other ❑ Specify:
Brief Description of Proposed Work2:
SECTION 4:ESTIMATED CONSTRUCTION COSTS
Item Estimated Costs: Official Use Only
(Labor and Materials
1.Building $ b pLr_ 1. Building Permit Fee-.$ Indicate how fee is determined:
2.Electrical $ 0 Standard City/Town Application Fee
0 Total Project Cost'(Item 6)x multiplier x
3.Plumbing $ 2. Other Fees: $ ���
4.Mechanical (HVAC) $ List: `
5.Mechanical (Fire $
Supression Total All Fees:$
_ Check No._Cheek Amount., Cash Amount:
6.Total Project Cost: $O1 50U ❑Paid in Full ❑Outstanding Balance Due: T
1 l ( 2S rnnI I N 5
SECTION 5: CONSTRUCTION SERVICES
5.1 Construction Supervisor License(CSL) -
�19
Lo. t I 1 &A � Lrcense Number Expiration Date
Name of CSL Holder
List CSL Type(see below)__AJ_
F nrrut- es
o.and Street Description
'� U Unrestricted(Buildings u to 35,000 cu.ft.
�-- 1` to t 7- Restricted l&2 FamilyDwelling
City/Town,State, M Masonry
RC Roofing Covering
wS window and Siding
SF Solid Fuel Burning Appliances
qlgI Insulation
Telephone Email address D Demolition
5."epstereed 3
ome Improvement Contractor(IOC) (`, ;1-J _
[[TT//�nnty 1lrrll AIt 1b W S 19CRegistration Number Expiration Date
Inc Com an ame or HIC Registrant Name
ED 13�- f�
' ,gyp q p� � �02— N 7 Email address
Ci /fown State,LIP o� Telephone
SECTION 6:WORKERS'COMPENSATION INSURANCE AFFIDAVIT(ALG.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 ..........4& 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 ' �'f A— 1e F j )i�na►�
to act on my behalf,in all matters relative to work authorized by this building pemrit application.
ARr/rWE QA.:r-re 1� L• -tit
No Owner's Name(Electronic Signature) Date
SECTION 7b:OWNER'OR AUTHORIZED AGENT DECLARATION
B entering m name below,1 hereby attest under the pains and penalties of perjury that all of the information
Y g Y Y P P P 1urY
contained in this application is true and accurate to the best of my knowledge and understanding.
Print Owner's or Authorized Agent's Name(Electronic Signature) Date
NOTES: .
1. An Owner who obtains a building permit to do his/her own work,or an owner who hives 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 can be found at
%ww.nrass.gov//oca Information on the Construction Supervisor License can be found at www.mass.eov/dns
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.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"maybe substituted for"Total Project Cosy'
West Essex Condominium Association
394 Essex Street
Salem, MA 01970
October 31, 2016
Ms. Arielle Waite
394 Essex Street,Unit 3
Salem,MA 01970
Dear Ms.Waite,
The West Essex Condominium Association has approved your request to have Pella Windows
and Doors replace four(4)rear facing windows on your unit.
Thank you,
West Essex Condominium Association