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23 FRANKLIN ST - BUILDING INSPECTION The Commonwealth of Massachusetts Board of Building Regulations and Standards CITY Massachusetts State Building Code,780 CMR,7°edition OF SALEM Revised January Building Permit Application To Construct,Repair,Renovate Or Demolish a 1,2008 �^ l One or Two Family Dwelling Building Perit�N b r e rpdidd signature r. Bmlding o sigpet s�'eata of �� 'F' e u.- 1.1 Property Address: : 1.2 Assessors Map&Parcel Numbers 3 f/q.1nK�y 1.1 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: Zone: Outside Flood Zone? Municipal❑ On site disposal stem ❑ Public❑ Private❑ Check if yes❑ p po To 2.1 Owner'of Record: J/ (f Iy1cr K i661 Name(Print) Address for Service: . Signature Telephone SECIICIN=3„DE5C"RIPTAON RE7 S W6RK (cpecli all that apply) New Construction❑ Existing Building❑ Owner-Occupied ❑ Repairs(s) ❑ 1 Alteration(s) ❑ Addition ❑ Demolition ❑ Accessory Bldg. ❑ Number of Units Other ❑ Specify: Brief Description of Proposed Work': x-44O O i -1 el �� CcrJ SECTION 4:ESTIM �EI? UIYSUIIOIV,COSTS' Item Estimated Costs: gflici>ih:Use,©nly Labor and Materials w 1.Building $ M` Butl mgparinitFee:`$ 16dicate how feeds determined: T3'SWdafd iCilV1Tow i Application.Fee 2.Electrical $ p otaCP%jai Co is(item G)is rtigI iter x 3.Plumbing $ tliIte _ 4.Mechanical (HVAC) $ Erb a 5.Mechanical (Fire Suppression) $ otal7k5sr � Check Amount: Cash Amount: 6.Total Project Cost: $ // 406 paid toFull Q Outstanding Balance Due: . sECTrolyss toretrcg =slztvlc�s 5.1 Licensed Construction Supervisor(CSL) M (C� a e L C�ti License Number Expiration Date Name of CSL-Holder ,^1 List CSL Type(see below) I/ i.J L�U e( Lt� I)`P E�SCe.Q¢iLL,�. �e .r "-Dbsbri'tiod- Address U Unrestricted u to 35,000 Cu.Ft. R I Restricted 1&2 Family Dwelling J � Signature M I Masonry Onl 3 RC I Residential Roofing Covering Telephone - WS. I Residential Window and Siding SF IResidential Solid Fuel Burning Appliance Installation. D I Residential Demolition 5.2 Re istere 1 H e I tprovement Contract��IQ 1D HIC Co Namet n} G Registration Number n o M yl/ 7 —J-CLf 4 Address 1 I n^ Expiration Date A-A Signature / Telephone SECTION;6 WORKERS'GOMPENSAT1gN INSURANCE AFFIQAYIT,(1GI G.L.e.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 Afdavit Attached? Yes No ❑ SECFION 7a -.dWNER AIJT(i(D ZA!IOIV 13 Cx 1V7''Wi MIEN 7777777777 OWNER'S:AGENTORC0NTI;ILACLCIRAYPJ S3 OI B.US1 INS=P Rlkl 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 application. a � Si nature of Owner Date SECT©N,7b ? SI y� 1D AGE)V L T)tCL.4Wo4r, 1" I? as Owner or Authorized Agent hereby declare that the statements and information on the foregoing application are true and accurate,to the best of my knowledge and behalf. � �lL Print Name - J _/IA ��L—� Signature of Owner or Authorized Agent Date Si ned under the ams and enalhes of r'u 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.G.L.c. 142A.Other important information on the HIC Program and Construction Supervisor Licensing(CSL)can be found in 780 CMR Regulations I IO.R6 and I IO.RS,respectively. 2. When substantial work is planned,provide the information below: Total floors 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"