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27 HANSON ST - BUILDING INSPECTION The C'onunontse:dth Of MassachusettS Board of Buihiing Regulations and Standards CITY OF t Massachusetts State Building Code. 780 CNIR SALEM 'L,,,. Ke rie'ed.I Lu•_'ll l l t\ Building Permit Application To Construct, Repair. Renovate Or Demolish a a One- or Tivo-Fanfilv Dtvelthkif This Section For Official Use Onl Pthis t Number: Matte Applied: al(Print Name) Signal Date SECTION I:SITE INFORMATION dddress: 1.2 Assessors Map& Parcel Numbers cepted street?yes no Map Number Parcel Number 1.3 Zoning Information: 1.4 Property Dimensions: Tuning District PmpuseJ Use Lot Area(sq It) Frontage(11) 1.5 Building Setbacks(R) Front Yard Side Yurdsr Rear Yard Required Provided Required ProRequired Provided 1.6 Water Supply:(M.G.I.c,40,§Sa) 1.7 Flood Zone Informatio8 Sewage Disposal System: Public❑ Private❑ Zone: _ Outside Flood unicipal ❑ On site disposal s stcm ❑ Check ifcs0 ) SECTION2: PROPERTY O ' 2.1 Ownerl of Record: Nano(PnnO T Uq•. at, 7 ��d S°�andd S' t TelephoFmoil AddressSECTION J: DESCRIPTION OF PROPOSED ck all that apply)New Construction❑ Existing Building❑ Owner-Occupied ❑ Alteration(s) ❑ Addition ❑ Demolition ❑ 1 Accessory Bldg.❑ Number of Units_ Other ❑ Specify: Brief Description ofProosedWork-: T7� - �( •- + / 44n / — , SECTION 4: ESTIDIATED CONSTRUCTION COSTS licm Estimated Costs: Official Use Only (Labor and .Materials) y I. Building S r I. Building Permit Fee: S Indicate how fee is determined: '. Electrical g ❑Standard CityrTown Application Fee ❑Total Project Cost'(Item 6)x multiplier ?. Plumbing S. '. Other Fees: S — - "-"—"- 4—Mcdtanice1 111\':\('1 S List: ---- ---- ------- -- ! <. Mcdtanical (Fire Su i ucssionl S Total :\II Fees: S .__... r Check No, _ _Check:\ntount: _ _ Cash Amount: t,. Total Project Cost: 5 4f a('� �1� ❑p;tid in Full ❑Outstanding B:d:mce Due: _ +��f 0 'O a SECTION 5: CONSTRUCTION SERVICES 5.1 Construction Supervisor License(C'SL) I Lic¢nsc Numhcr P�pl elion D:ue (� //��/���� ��// List('St.1)pe(see MONO /-" l1�- �----- ----------- 1')pe Description No. and Strect ll l4vcstricled IBuildin s u' to 15,UIW cu. Il.l R Restricted I:L2 F roil Dllcllin o%%n..State.LlP M1l Masonry RC Rmling Coverin -- A Window and Siding SF Solid Fuel Burning Appliances a I Insululion 1'ele hone ilmul address D Denndilion 5.2 Registered Home Improvement Contractor(HIC) f — I IC R©istratiun Nunn i.spira i n Dulc I li�binpall Name or 1IIC Ito Istrant Name No. .nd Struct — s.) / Linail ad •ss ,�U 7 Ci own;State,'ZIP rele hone SECTION 6:WORKERS'COMPENSATION INSURANCE AFFIDAVIT(M.G.L.e. 152. 1 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 Issuangg of the building permit. Signed Affidavit Attached? Yes ......... Nu........... ❑ 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 to act on my behalf,in all matters relative to work authorized by this building permit application. S>yG �' rr>!! �� / / Print Owner's Name ffixt Signature) Dal SECTION 7b:OWNERI 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. Pr nt Oil ner i ar:\u onied Agent s Name .I tuna. igl,luir _ Dale NOTES. 1. An Owner whu obtains a building permit to do his,her own work,or an owner who hires an unregistered contractor (not registered in the Hume Improvement Contractor(HIC) Program),will no have access to the arbitration program or guaranty fund under NI.G.L. c. I42A.Other important information on the HIC Program can be found at lull m.i,, % ti.l Information on the Construction Supervisor License can be found at >l ll.nios;�n do, 2 When substantial tvurk is planned, provide the information below: Total Iloor area(sq. R.) _-._(including garage. finished base rient'attics,decks or porch) Gross living area(sq. 11.) _ Habitable room count Nunhbcr of fireplaces___.. _. _ ...— `umber of bedrooms Numher of'hathrooms . —-- Number of half halths - 1\lie of heating s)item .. ... . -_ Number of decks, porches 1.1pe of chilling i)stelll _ .. - - Enclosed _. .. . Open _ 1. "Total Proico Square Foolage"nla) he substituted fihr"Total Project Cost-