18 FELT ST - BUILDING PERMIT APP The Commonwealth of Massachusetts CITY OF
Board of Building Regulations and Standards SALEM
Massachusetts State Building Code, 780 CMR Revised.Ifar 201/
Building Permit Application To Construct, Repair, Renovate Or Demolish a
One-or Two-Family Divelling
This Section For Official Use Onl
l,4� Building Permit Number: Date plied:
Building Otticial(Print Name). Signature-: ' Date
SECTION 1:SITE INFORMATION' ^'
1 r) I.1 Property Address: L2 Assessors Mapdt Parcel Numbers H
1.1 a Is this an accepted street?yes_ 110 Map Number Parcel Number
� � rn
1.3 Zoning Information: 1.4 Property Dimensions: M
n(1 1LZi 617d W=
IL1J Zoning District Proposed Use Lot Area(sq It) Frontage(It)
} - 1.5 Building Setbacks(R)
Front Yard Side Yams Rear Yard aer
-
rr
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:
Publiclfl Private❑ Zone: = Outside Flood Zone? MunicipalK On site disposal system ❑
Check if vesC3
SECTION2: PROPERTYOWNERSHWP
2.1 Owner'of
rvtu f-t }R ecIortdn QR ' �h^ W'Mmtce(Prin) City, { te,ZIP
R�sS 33� ats°i mr3uG-r�� r ,�nwow�c stU �(o,cu�
o vrd Strcct Telephone Email Address
SECTION 3: DESCRIPTION OF PROPOSED WORKS(check all that apply)
New Construction❑ Existing Building Owner-Occupied ❑ 1 Repairs(s) if. Alteration(s) 05- Addition ❑
Demolition ❑ Accessory Bldg.it Number of Units_ I Other ❑ Specify:
Brief Description of Proposed Work': M - l
lo U o° 3t 4
RCP�a� Ctrotrtf f+fPMte wnY�oc� l booP—
SECTION 4: ESTIMATED CONSTRUCTION COSTS IWO
Estimated Costs: Official Use Only
Item Labor auJ Materials)
I. Building $ I. Building Permit Fee:$ Use
how fee is determined:
❑Standard City/Town Application Fee
2. Electrical $ ❑Total Project Cos!'((tern 6)x multiplier x
3. Plumbing $ P Qther Fees: $
4. Mech:urical (HVAC) S List:
E6.'rotai
al (Fire S 'fatal Ail Fees:S
)
Greek No._Check Amount: Cash Amount:
oject Cost: S SDO® . ❑pail in Full ❑Outstanding Balance Due:
1
SECTION 5: CONSTRUCTION SERVICES
5.1 Construction Supervisor License(CSL)
License Number Expiration Date
N:unc of CSL Holder
List CSL'rype(see below)
No.:md Sweet
Type Description
D Una5lricted Buildin s up l0 35,000 cu. Il.
R Restricted 1&2 F:unil Dwellin
Cityfrown,Slate,ZIP M Masonry
RC Rooting Covering
WS Window and Sidin
SF Solid Fuel Burning Appliances
I Insulation
Telephone Email address D Demolition
5.2 Registered Home Improvement Contractor(HIC)
HIC Registration Number Expiration Date
HIC Company Name or HIC Registrant Name
No.and Strcet Email address
City/Town, 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 ..........❑ No...........O
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
t9 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
cot lied in this application is true and accurate to the best of any knowledge and understanding.
no �
t Owner's or Authorize Ag n (Electronic Name(Elecnic Signature) Date
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 LLoj have access to the arbitration
program or guaranty fund under hI.G.L.c. I42A.Other important information on the HIC Program can be found at
wwvv mass cov:'oct Information on the Construction Supervisor License can be found at+vww.mass.aov'dns .
2. When substantial work is planned,provide the information below:
'rotal floor area(sq. ft.) 9 .(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 healing system Number of decks/porches
Type of cooling system Enclosed Open
3. "Total Project Square Footage"may be substituted for-rotal Project Cost"