1 MALL ST - BPA-2013-121 --- I'lie C'om,numve:dlh of biassachuscus
y, Board Of Building Regulations and Standards ( I I'1'OF
sr,
L, \fassai•husetts Shue Building Code, 7SO C'hIR SALEM
\ � ' �.. Reriss'i/.I Lrr'llll
Building Permit Application TO C'onslrtict, Repair. Rcnuvate Or Demolish a
1 011e•or Tun-Piunll, Dirrllhnq
This Section For 011ieial Use Onl
Building Permit Number: Date A plic
wilding Official IPrintSignat Iulc
SECTION I:SITE INFORMATION
1.1 Property Address: 1.2 Assessors flap& Parcel Numbers
1 a.c� S� <7L 2'1 _
I.la Is this an acre led street?yes no Map Nllill3� Parcel Number
IJ Zoning informatlotr: 5`A344c.1G ,r,r� Li Property Dlmenslons:
f astatat�" Y,,31
19 '3 z
Coning District 1'nipused tlws Lill Arco(sq III Frontage III)
1,3 BulldIng Setbacks(R)
Front Yard Side Yams Rear Yard
Required Provided Required _ Provided Required Provided
1,6 Witter Supply:(M-G.1.c. 40,§34) 1.7 Flaad Zone Information' Lg Sewage Disposal System:
hiblic CX Private O zona _ Outside Flood zona?
Chock ifc Munieiptd�On silo disposals)stun O
SECTION 2: PROPERTYOWNBRSIt1Ps
2.1 Owner'of Record: _
2r�– cz, I.nsCv`fw.G Se.���.. -c 61Aca ens—IC?
N;unc l rnoU city.State.ZIP
J a.t .ate- 4zfL Y Lf .1G
No.:u,J Street relcphone hinml Address
SECTION J. DESCRIPTION OF PROPOSED WORK'(check all that apply)
New Construction E.rislinyBuildinyyi( Osvner•Occupied RI:- Is 11 Je; Alleration(s) O Addition ❑
Demolition ❑ Accessory Bldg,❑ Number of I Wo. Other O .Spccq:
Brief Description of Proposed Work':
SECTION 4: ESTIMATED CONSTRUCTION COSTS
Itcm Estin,alcd Costs:
(L abur and.\Iaterials) 011iclul Use Only
I. Building S ee)® I. Building Permit Fee: S Indicate how ICC is determined:
!-2. Flecirical S ❑Standard City Tusvn Application Fee
I ? I'IumMng S ❑Total Project Oust'I llent 6),% multiplier
_. Other Fea: S
J. \kch.mii.d ill\ \('1 i LisC.- -'_--
3 \IKh.11lie.Il iFue
1�u.vcssionl S rntal .\IlFces:
0 Total Project Cust: S 3 (Iteek \b. _. _Check:\nunu
sC3 LsQ ❑P.id in Full ❑Outstanding Bal.usce Due:
sj.'Cl ION 5: oNS I'MICTION sF.KVICFA
I't0l. I**. JW1cVl,0tm)
-------- Pq:
Dcseription ..
No, and sircd
10W I&I I .........
R T14ci
isioll
Cipi loan,`tat¢.LIP
KC' R,X,Iill Cu,aria
%k S Window Lnd Sidill
fuel
11"M es
Solid Fucl IlUmin 8 Appliallc9s
Institution
fele hone
I(mai I addrvm D
Demolition
4.2 Registered Ilume Improvement Contractor V110
1:%piriltion Date
III( ltql�jrlllon Nunitivir
ll[CC%llllpjll) -11,10"I IIC Itegistrunt Name
Nu. olid Struet -----
I L ityfrown, state zip file hone
SECTION 6:WORKERS'COMPENSATION INSURANCE AFFIDAVIT(M.G.L.e. 152.1 ISC(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 ..........CI No...........C3
SECTION f@: OWNER AUTHORIZATION TO BE COMPLETED WHEN
OWNER'S AGENT OR CONTRACTOR APPLIES FOR BUILDING PERMIT
Lal_ocaner ofthe rperty,hereby authorize
t act on M ch I in all lo
lnite 7rel I work authorized by this building permit application
i;ls�I;k
.�v Lrate _
prilit O„ller'll Nunld
SECTION 7b:OWN ERWR 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.
Dote
Print of.mithori,vu Av-
NarES.
. 7 ;-o%vncr%vhohircsainluiiregistcrcd%:oiitrioor
I. An Owner who obtains a building permit to do his, trown work,oran '' ' "t'
actor i H 10 Program).will have access to the arbitration
-c
1. d
'Jal 0 p "ull at
(nut registered in the Hume 1111provellient Cuntr rini can be found at
program or guarant) fund uiider.\I�G.L.c- Other impunant information on the HIC,Program
a e n _"k .It"
I can be found at ��,A Iii,
I information an the Construction Supervisor License
infurisiation below: lls�le� as.111, its it ii"rll)
lien substantial%wrk is planned, provide the .11t.111 s,decks or Porch)
11cludilig gjrage. 6nished bascowntall'"
notal flour area iq- 11 Habitable too",cOtllit
G rosi It%ing area 154. Ntliliber ot'hedrutims
porches
I Ilk:of lic-11ilig i)Stem
Fllclo'cd
of�oofillg '.S OcIll
J"! %lb,litutcd i1or l'otal Proje%;t COA
----------- -------- -------------- II
3-#4 dowels- I _— -- I I I I 3-#4 dowels-
groutI L ----- rout into wall
b
Into wall I I II II II
II II II II
I I I I I I I I
I I I I I I
I I 1 I I I I
PLAN
SCALE:1/4"=1'-0"
Solid blk. Solid blk.
2x wood plate and A.B. .
horiz. bond bm.
---__ I
I
2x4 wall #8 vert. F
2-2x8's-support ea. end support
1/2^A.B. I grout
Bond Beam
r
. @ GMUalldurowall e.o.course I p wall e.o.coursel #4¢owelsl I #4 gowelsl
I I lid
I EAist cohc.slab I I Exist conk.slab I I I I
eSECTION @ BUTRESSe SECTION @ END WALL
5CAl.E:1/2"=1'-O" SGALE:1/2"=1'-O"
#1 DATE:
MALL ST
ROBERT I. MFFNIK A.I.A. 07i31n2
FOUNDATION REINFORCEMENT 186 MAIN ST. SCALE:
SALEM MA.019703699 GLOUCFSTER.MA.01930 As Noted
TEL. 37579
FAX(978)
Plans and Sections
i •i4, :..y. Tr
AS
GLGJCES1kl
��Ln of
74'
--------- -------- -------- II II
3-#4 dowels- I I_ —_ -- I I I I I 3-#4 dowels-
grout Into wall ---- -- rout into wall
I I b I I I I I I
I I a I I I I I I
1 L
I I I I I I I I
I I I I I I I I
I I I I I I
I I 1 I I I I
PLAN
SCALE:114'=1'-O"
Solid blk. Solid blk.
2x wood plate and A.B.
_ horiz. bond bm.
I
I
WOll
#5 vert. 2x4 wall
2-2x8's-support ea. end 2-2x8's-support
1/2"A.B. i Fill w/grout
1464
r
N 6x6 Bond Beam
� 2x10
1/2"A.B. @ CMU
s
I 2x4 wall
durowall e.o.coursei p durowall e.o.course
I �
I
#4 OowelslI .sill I #4 qqowelsl I
I Eiist cohc. slab I I Exist conk. slab) I I I
SECTION @ BUTRESS 8 SECTION @ END WALL
SCALE:1/2"=1'-0" SCALE:1/2"=1'-O"
#1 DATE:
MALL ST
ROBERT I. MTTNIK A.I.A. 07i31n2
FOUNDATION REINFORCEMENT 186 MAIN ST. SCALE:
SALEM MA.019703699 ,GLOUCESTER.MA.01930 As Noted
TEL.(978)283.7579
FAX(978fi
L'283'.6288
Plans and Sections