21 FAIRVIEW RD - BUILDING PERMIT APP The Commonwealth of Massachusetts
� �PECTIOWAI SEF WORM OF
A 1 Board of Building Regulations and Standards
ALEM
Massachusetts State Building Code, 780 CI� SdMar
[U16 MAR 29 A gyledMar20!!
A^ Building Permit Application To Construct, Repair, Renovate Or emolisb a V
IN One-or Two-Family Dwelling
00 - This Section For Official Use Only
N Building Permit Number: Date Appf
J Building Official(Print Name) Signature V Date
I - SECTION 1: SITE INFORMATION
1.1 Property Address: 1.2 Assessors Map&Parcel Numbers
t �1 Ftli-yo ,0- RI
I-" L l a 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(sq ft) Frontage(ft)
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: 1.8 Sewage Disposal System:
Public❑ Private❑ Zone: _ Outside Flood Zone? Municipal ❑ On site disposal system ❑
Check if vesO
SECTION 2: PROPERTY OWNERSHIP'
2.1 Ownerr-of-Record:
.70/ktiy 6' Nose 5a lVlf, M ct
Name(Print) City,State,ZIP
9( r-mtrVleu..- RcL 9>�-979-9aH3
No.and Street Telephone Email Address
SECTION 3:DESCRIPTION OF PROPOSED WORle (check all that apply)
New Construction❑ Existing Building ll� Owner-Occupied KrT Repairs(,) 8- Alteration(s) ❑ 1 Addition ❑
Demolition ❑ Ac I Other ❑ Specify:
Brief Description otProposed Work: -ep!AC-c Dead t S'i'eei YtS
SECTION 4:ESTIMATED CONSTRUCTION COSTS
Item Estimated Costs: Official Use Only
Labor and Materials
1.Building $ aS0D0 1.. Building Permit Fee: $ Indicate how fee is determined'.
❑Standard City/Town Application Fee
2.Electrical $ ' - -
❑Total Project Cost (Item 6)x multiplier:. X ;
3. Plumbing $ 2. Other Fees: $
4. Mechanical (HVAC) $ List: t/2�C711 D
5.Mechanical (Fire $ Total All Fees:$
Su ression
^G _ Check No. Check Amount: Cash Amount:
6. Total Project Cost: $ dOJDOO ElPaid in Full ElOutstanding Balance Due: -
SECTION5: CONSTRUCTION SERVICES
5.1 Construction Supervisor License(CSL)
ReiYeKT Dob•e License Number Expiration Date
Name of CSL Holder
��y/ (( ��JJ 11 List CSL Type(see below) ()
la
No.and Street Type Description _
U Unrestricted(Buildings up to 35,000'cu.ft.)
4 R Restricted 1&2 Family Dwelling
City/Town,State,ZIP M Masonry
RC Roofing Covering
WS Window and Siding
SF Solid Fuel Burning Appliances
I Insulation
Telephone Email address D Demolition
5.2 Registered Home Improvement Contractor(HIC) /O;?�a
/ A6,oK-r nobs HIC Registration Number Expiration Date
HIC Company Name or HIC istrant Name
of &<Re Rd 0.,S;<�,CRPNrftY �NvG.re
No.and Street Email address
7`edc. Zie Ma o/99r3 VP-jai-/Oar/
Cit own, State,ZIP Telephone
SECTION 6: WORKERS'COMPENSATION 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 ..........Pr' No........... ❑
SECTION 7a: OWNER AUTHORIZATION TO BE COMPLETED WHEN
OWNER'S AGENT OR CONTRACTOR APPLIES FOR BUILDING PERMIT
1,as Owner of the subject property,hereby authorize 06ii' ✓vIi�
to act on my behalf,in all matters relative to work authorized by this building permit application.
6e o Nt . d'kae- 3- ;-s--ao/ �
Print ner's Name(Electronic Signaturey Date
SECTION 7b:OWNER`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.
RA-ea aubv- 3 3�--ao/ L
Print Ownef 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 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.C.L.c. 142A.Other important information on the HIC Program can be found at
www.mass.gov/oca Information on the Construction Supervisor License can be found at www.mass.¢ov/dps
2. When substantial work is planned,provide the information below:
Total floor 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"maybe substituted for"Total Project Cost"
CLIENT:
Thomas and Joan
OHare
JOE LOCATION:
dd'bla 21 Fairview Road
10 Salem, MA
10 T-11' to 211`7 lr 01970
—
3'-5 VC d'd tr- B'-1 7/4' OW B 8.1 We'
10
o
BeB G.T.ooWmm (q 2x Bloater (2)21,128eaao
even existing Pooanps M header at See Oatal on A,21t
W 15 Brkk Veneer
R6en _ 1 T if 11 Ir —If-. (r T I
I II II II II II II II II I � II II II II II II 11 II II III II II II II III II II II II II II II II II II III a
I it II' II II II II it II I Ii II II II II II II II 0 II III II II II II III II II II II II II II II II II III �e
IIIIIIIIIIIIIIIIIIIIIIIIIIIIItIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIII �
II II II II II II II II II II II 11 11 11 11 11 H 11 111 it II II II 111 11 11 11 11 11 11 li 11 11 11 111
r. I fB �* I II II II II II II II it it 0 II II II II II 11 II II II III II it II II III II II II II II II II II II II III �
I II $ a I II II II II II II II II II II II II II II II II II II II III II II it II 111 II II II II II II II II II II III
� � a I II II II II II II II II II II II II II II II II II II II III II II II II III II II II II II II II II II II III S'
a III II II II II II II II II II II II II II II II II II II III II II II II III II II II IIiiillllllllllll
I II II II II II II II II II II II II II II II II II Y II III II 11 II II III II II II II II II II II II II III m
r„ II II II II II II II II 11 h 11 11 11 11 11 11 11 11 11 111 11 lI II II III II II II II Ii ll ll ll ll it all'
g I II II II I II it II II II II II II II II II II II II II II II II II III II II II II III II II II II II it II II II II II I
I II
I II II II II II II II II II II II II II II II II II II II III II II II II III II II II II II II II II II II II I
M I II II II I II II II II II 11 11 11 11 11 11 11 11 11 11 11 11 11 11 10 11 11 11 11 111 11 11 11 11 11 11 11 11 11 11 111
— j -it 11 11 --JLIL=9 J--JL L=0--iL ! JLJ_IL A J=L 1 j=LLJIJI
a
J.N.: SCALE:
1B-0Bi Di ild'=1'•P
SHEET:
A-110
CLIENT:
b Thomas and Joan
N OHare
Op
10
'�t6 'III II JOB LOCATION:
JIE hd 21 Fairview Road
Salem, MA
g a
01970
L
b N b CC LI
I
mq�
i
Q
J.N.: SCALE:
16001.01 12.-V.0.
— —_— SHEET:
A-210
CLIENT:
Thomas and Joan
Exerting Slider Dom Booting Sider Dom OHare
Eximting SubRom Udnp SLbRom JOB LOCATION:
21 Fairview Road
Salem, MA
01970
Eolwix(lA kDec Rww Jeiels Exb jxIl AzOTbm Mew
ng
New9ae PukDeeldnp New{x BAxek Oeckmp
MOMWERMEM .........�....wwn..
C m
Now Slmpeon ESRTSTO&eekol 1rlx. O c (2)&eokeb®Eado Dom Opo*g i�a ��„ NowSlmpeon ESR 2523 Stardom
(T)Broekeb®Each Door OmNng
New xBP.T.Rim Jobd -- Now Tx6 P,T.Rim JdN
New x 6 Blooding New x 6 Booking
Now 2 x B One Jnbb®12'O.C. — Newt x B Cook Jnleb@IrO.C.
Existing BridrVenew EAsMg&lek Venur m
ExiOng Steel U-Beam Exhtlnp Sbd U•Beam
a
SCALE:
Existing Slider Dom ExIoUng Slide,Door 16401.01 9'=1'•0'
DedCammetlen DeteY'A' Dock Comedian OoW'B SHEET:
A dab e ( s gJoleb PeopmeficaluT A-211