Loading...
The URL can be used to link to this page
Your browser does not support the video tag.
13 MASON ST - BUILDING INSPECTION (2)
The Commonwealth of Massachusetts Board of Building Regulations and Standards CITY Massachusetts State Building Code, 780 CNIR SALEM Revised Mar 2011 Building Permit Application To Construct, Repair, Renovate Or Dean ish One-or Tivo-Family Dwelling This Section For Official Use Only Building Permit Number: Date A plie'd> f Ulm z cS Building Official(Print Name) Signatufef,. Date " SECTION 1: SITE7NFORtINIATi 1.1 perty Address: 1.2 Assessors Map eel Numbers 4[7,o-7 5-7- 1.1 a Is this an accepted street?yes no Map Number - Parcel Number 1.3 Zoning Information: 1.4 Propert i nsions: Zoning District Proposed Use Lot Area(s 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 yes❑ . SECTION 2:, PROPERTY O . RSHIP,- 2.1 wnnetr)t of Recoravtg- d; e, �m� 6Y9� City, Star Street Tele one Email Address SECTION 3: DESCRIPTION OF PROPOSED WORK'(check all that apply) New Construction ❑ Existing Building Cl Owner-Occupied ❑ Repairs(s) ❑ 1 Alteration(s) ❑ Addition ❑ Demolition ❑ Accessory Bldg. ❑ umber of Units_ I Other ❑ Specify: Brief Description of Proposed Work': SECTION 4: EST IivIA'TEB CONSTRUCTION COSTS-- Estimated Costs: Item Official Use Only Labor and Materials 1. Building S 1 Building Permit Fee $ Indicate how fee is determined: Electrical $ ❑ Standard City/Coign Application Fee 2. ❑Total Project Cost'',(Item 6)r multiplier x 3. Plumbing $ 2 Other Fees. $ � � 1. Mechanical (FIVAC) S List: �/ 5. Mechanical (Fire $ Sn� rl p ession) 'Coral All Fees: $ Check No. Check Amount: Cash Amount. 6. "Coral Project Cost: S 0 Paid in Full 0 Outstanding 13alance Due: SECTIONS: CONSTRUCTION SERVICES 5.1 Cottstruetion Supervisor License(CSL) License Number Expiration Date Name of CSL 1lolder List CSL Type(see bzlow) Type Description No. and Street U Unrestricted(Buildings s up to 35,000 cu. ft.) R Restricted L&2 Family Dwelling City/Town, State, ZIP NI Masonry RC Roofing Covering WS Window and Siding SF Solid Fuel Burning Appliances I Insulation rcle hone Email address D Demolition 5.2 Registered Home Improvement Contractor(IIIC) HIC Registration Number Expiration Date IIIC Company Name or HIC Registrant Name No. and Street 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........... ❑ 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 b alf, in all matters relative to work authorized by this building permit application. i lime(Electronic Signature) 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. Print Owner's or Authorized Agent's Name(Electronic Signature) Dnte 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 not have access to the arbitration program or guaranty find under M.Q.L. c. 142A. Other important information on the IIIC Program can be found at %oww.massj,ov/oca Information on the Construction Supervisor License can be found at www.tnass.^_uv�dL 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. 11.) _ Habitable room count Number of tircplaccs._ Number of bedrooms Number of bathrooms dumber of halVbaths _ Type of heating system --- — — Number of decks/porches 1'ype of cooling system F.nclosal _ Open 3. `'Total Project Square Footage" may be 9UbitlnitCd t�)r.ToMl Project Cost" -----" ------,—__—_--- CITY OF S.UY.Nf PUBLIC PROPERTY D EPARIPMEN'T u.v.aasr o•srnu `r"'°e �]0 r.a•„cros.struar•SK.,�VNua,a,srrs Otfro rrL s-s.z,s.�sss•r.s.r.s.�,o�w HOMEOWNER LICLNSS EXE.I MON Plesw Met �- Job Loeadols Home Owner Addteao Home Owner Telephone Ptesstt Mailing Address The current exemption of"Homeowners"was extended to include owner-occupied dwellings of two Units or leas and to allows Such homeowners to engage an individual for hire who don not possess a license provided that the owner acts an supervisor. DEFiNMON Of HOP"OWNER Person(s) who owns a pnteel of land on which WdW resides or intends to reside.on whicb them is, or is intended to be6 a one or two timily dwroWng, atteched or detached structures accessory to such use and/or lbrm structures. A person who constructs more than one home in a two year period shall not be considered a homeowner. Such -homeowner"shaA submit to the Building Omeial,on a forth acceptable to the Building Official. that helshe be responsible for all such work performed under the Building Permit. The undersigned "homeowner"assumes responsibility for compliance with the State Building Code and other applicable by-laws and reguladortL The undenigned "homeowner'certifies that hdsho undentands the City of Salem Building Department minimum inspection procedures and requirements and that helshe Will comply with said procedures and requirements HOMEOWNERS SIGNATL APPROVAL OF SUMDENC NSPECTOR See other side for state code CITY OF S. L.Etit, �,LxsSACHUSETTS ©L'm=NG DEP.\R't%MNT Jr 130 WASHNGTON STREET, 3° FLOOR T EL (978) 745-9595 FA.K(978) 7.10-9846 Ki.NmERLEY DR ISCOLL 4LNYOR Tmouas ST.PtERRa DIRECTOR OF PUBLIC PROPERTY/BCILDNG CONLMISSIONER Construction Debris Disposal Affidavit (required for all demolition and renovation work) In accordance with the sixth edition of the State Building Code, 780 CMR section 111.5 Debris, and the provisions of MGL c 40, S 54; Building Permit a# is issued with the condition that the debris resulting from this work shall be disposed of in a properly licensed waste disposal facility as defined by MGL c t 11, S 150A. The debris will be transported by: bOY 5rd+� Cogrtl y'114 (name of hauler) The debris will be disposed of in : .7/ ^CA (name of facility) ,IW&& (address of facility) L./ gnature of permit applicant elate drbn ol(.I,H: