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32 FAIRMOUNT ST - BUILDING PERMIT APP �y9" --- :1 I'he C'onununwrahh of��t:usachuseus r: BuarJ oPBuilding Regulations ;old SlandarJs CI'I'1' OF ;r "'ls.c;trhusctts Slaw Building Cude. 7SB(AIR SALEM Building Permit ,application To Construct. Repair, I uv, e Or Densulish a lbrc-ur row-Pin td Dwd el This Beckon Fur 011 ci 011 Building Permit Humbert Date. plied- IhulJmy Qllicial(Print Ntune) "f l . i al re Dola SECTION 1: SITE INF ON t ropert Address: 1.2 Asia sur , lap dt Parcel Numbers I.la Is this an acce ted street? es 1/ no Map Nunsh I urcel Numhcr 1.3 Zoning Information; 1.4 Property Dimensions: 7,11i116 Ustricl Pntpu+ed ll.ra Lul Arua(r I: 4 ► Pmntaya it-i) 1.3 Building Setbacks(R) Front Yard Side Yuma Required PruviJcd Roar YarJ Required Provided Required Provided 1.6 Water Supply;IM.G.1.c.JU, §!y) 1.7 Flood Zone Information; "a Sewage Disposal System: Ihsblle O Private Cl Zone: _ Outside Flood Zone? Check if vsC Munieipd O On site disposal s),uem ❑ SECTION2: PROPERTYOWNERSHIPt ,gwners of Rec ell 3C2TsITt�- ;oil (print) � ��-r �Gt •- ©r 9 70 C a),State.zip3Z7-i�P�tlayry r Sr- l/ ;>9-744-L3f3C) No..mJ Sln'el rele hone F tmml Address SECTION is DESCRIPTION OF PROPOSED WORKS(check all that apply) New Construction O Existing Buildiny❑ Owner-Occupied ❑ Repairs(s) ❑ Alterallon(s) Cl Addition ❑ Demolition ❑ Accessory Bldg. ❑ untberof Units Brief Description of Proposed Work": Other ❑ .Specify: w SECTION J: E31IJ1A I LD CONSTRUCTION COSTS hens Essimased Costs: f Lahur and\Lsterials) ORlclal Use Only I. Building S 1. Building Permit Fee: S Indicate how IBe is determined: `. Hwrical S ❑Standard City:Tussn Application Fee I 1 I'lumhntq S ❑Total Prujal C'usls l Item 6).1 multiplier _ _ x '. OlherFees: S — " - ' J, \Icchanicat ill\ \('1 S List: \Icdi.uuc.d I rare -- ----- ---•--- ... __ ..-_ �u . tic9siunl S rtaal .\11 Fees: f u 1'ntul Project Cult: i Check \u. C'r) ❑P.iid in Full C3(hnstmdinq Ilal.mce Doc: rill SECillyNil. ('(),NSI'RII(C i.l Construction Super I ice nee Norther I title pa Ihscripliun I i�I)00 ol NIT. .111J Sir"t Ii ''Ir"Ied I& Iri"vJ '7.unit Il,�cllin Is o 111 State.LIP IK It,x,till Co%erinNS m livilldo%% uld-NIU111111 SF solid Fuel Ilumilill'%pplialicc, lilitilution ! j;IiI iddrvl rel� hone L: Improvement Contractor(111C) .11.2 Registered lion 1t'Illr'lllklil Data IIIC Ctillipin) Name or 111C liellisiran Name lim4-11_45 J_M I_S � No. and Street rov hunt n State�ZWP 153.1 2SC(6)) _:ci��Town.Stale 014 INSURANCE AFFIDAVIT(M.G.L.C SECTION 61 WORKERS'COMPENSATION '�Jlcaflon application. to�PrGvids S N 145tj�lt�i with this application. Failure to Provide Wort Compensation Insurance affidavit�Must be�complcted and submitted this affidavit will result in the denial of the Issuance of the building Permit- No...........Q Signed Affidavit Attached? yes..........Cl --�------IIU—ZATIONTOBECONIPLETEID�VHEN SECTION is:OWNER AUTHORIZATION W CONTRACTOR APPLIES 1`10"t LL &6�TRA _ owNER'S AGENT OR CONTRACTOR APPLIES FOR BUILDING PERMIT i, as Owner of the Subject property,hereby authorize to act on my behalf,in all matters relative to work authorized by this building Permit OPPlicallon' Date prilit owner's Nwric(Electronic Signuturv) ------ ------ SECTION 7b:OWNER' OR�0.j'AUTHORIZED AGENT DECLARATION By entering iny name below, I hereby attest under the pains and penalties or perjury that all of the information .c2tI I Is. t ut and accurate to the best of my knowledge and understand ing. contained !it thylsa plI0n %Iry gym I I I I Sign r i121 .N,.0'rESt , u�11registered�nlrWur ------- - ----- her uNvn��wrk.Wall ONN a�h \n omitir%%hu obtail's a building permit to do his it(HIC) Program),will !U) hav access to the arbitration I lot registered in the Hume limpruvolient Cuntracti ther il"Porlant inrufnlat'on on I e HIC Program,,:-an be round at progra 11 or guar�uil) fund undvir M.G.L. 142A..0 an be round at k�%kl% W%'% i"I" .1, linformationkin the CunsIru%:ltcn Supemisor Lictrise C 2. Wien iubilall0alkW(K the ittrurmationbelow: I including garige, finished basement attics. Jerks err parclU rotai Moor area 1'4. habitable rou'll eut"'t using area 114. 11.1 Njilliber of hvdrooills bvr ofl-irvill-icv, \tuilher of 11-110,11114 Ntimberol hatill'0011's porches pv of IlvAllog i)'Iclll 1',r ,rot,d 11roick;t('0,1 loi,il Ilroiek.t i,111-1tv