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29 MASON ST - BUILDING INSPECTION (2) e t The Commonwealth of Massachusetts Board of Building Regulations and Standards CITY OF a , Massachusetts State Building Code,-730 CM ttfn R SALE? r 2011 Building Permit Application To Construct, Repair, Renovate Or Demolish a Rzvised One-or Two-Family Dwelling This Section For Official UsaOnly. Building Permit Number: DSEe Ap' ed ' ` . . Building Official(Print Name) �Signatuc :' i - Date SECTION L•SITE INFORt IAT19 P . L 1 Property Address: 1.1 Assessors Nf. & Parcel Numbers XFla 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(R) 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: 1.3 Sewage Disposal System: Public❑ Private❑ Zone: _ Outside Flood Zone? Municipal❑ On site disposal system ❑ Check if yes❑ SECTION Z; PROPERTII'OWNERSHIPL" ; 2.1 OwnertoCg$evord: /ems/ M/l O19 7O W�II'Am 15 s�o� Name(Print) City,State,ZIP '\ccq� 97$- 7yy-oSO7 Zi Ile �y yeo.. Con. No.and Street Telephone Eriadf Address SECTION 3: DESCRIPTION OF.PROPOSEDWORK''(checkall thatapply) New Construction ❑ Existing Building❑ Owner-Occupied ❑ Repairs(s) ❑ 1 Alteration(s) ❑ 1 Addition ❑ Demolition ❑ Accessory Bldg. ❑ Number of Units_ Other ❑ Specify: Brief Description of Proposed Nork3: 1 H'` r SECTION 4: ESTINLATED CONSTRUCTION COSTS- Estimated Costs: Item Official Use Only.., — Labor and Materials 1. Building g L Building Permit Fee:Sj Indicate how fee is determined: 2. F.lectrirel ; Q Standard.Cityf Iutvn Application Fee." 1.0'rotal-Prol'actCose,(Itirti.6).Vmultipliir—X 3. Plumbing S ?- Other Fzea: S I. Mechanical (IIVAC) 3 List: i. Mechanical (Fire $ SnP rossiun) _ Total All Fees:.S_ Check No. _Check Anount: ---Cash Amount: I'ntal Project ('ms[ 5 75 ❑ 1'Ad in Fidl ❑Outstandin; ISal,utcc IAie: SEc'rION 5: CONsrRUCrION SERVICES 5.I Construction Supervisor License(CSL) _ License Number Expiration Datc None of CSL I[older List CSL Type(see below) Type Description No. and Street U Unrestricted �uildin s u to 33,W0 cu. ft. R liestricted 1&2 Fanil D,wllin Cityirown,State, LIP ikI ',lasonr RC ROatI Covering WS WindowundSidin SF Solid Fuel Burning Appliances I Insulation I'elz hone Email address D Demolition 5.2 Registered Home Improvement Contractor(HIC) H[C Registration Number Expiration Date I IIC Company Name or I IIC Registrant Name No.and Street Email address City/Town,State 'LIP 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, is Owner of the subject property,hereby authorize to act on my behalf, in all matters relative to work authorized by this building permit application. Print Owner's More(Electronic Signature) Date SECTION 7b: OWNER' OR AUTHORIZED AGENT DECLARATION By entering my name below, I hereby attest undcr 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. Xi,.l:lliti� � �V51innS 466 (3 Print Owner's or Authurized Agent's Na (Electronic Signature) Date NOTES: I. ;1n 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 timd under M.G.L.c. 142A. Other important information on the FIIC Program can be found at www m:us.euv;oca Information on the Construction Supervisor License can be found at www.mai .,n�,v_dL 2 When substantial work is planned,provide the information below: Total floor area(iq. (including garage, finished basemtentlattics, decks or porch) tiro" living area(iy. it.) Habitable room count — Number of tirepLtce,_.---------- Number of bedrooms -- ------------------ Number of balltroottts Number of halEbaths — Ibpe of healing iyilcut _ --_._—.— Number of dxki;pnrchci \pe0fa001im iv;teln Einelused ripen -------- ---- -I„t,it l'nq.,_t iyu.ira Fool,we"m.ry hc ;nbitiuit'-d l�v'"f. ell lhuject (bit" CITY OF S.U-&Nt PUBLIC PROPERTY DEPARTMENT lu uitVlJ;1/eLr.v wwe �b.�wfw�or,sr.ear• lunar,w..oR�m anre rtL f'f7JL7t1f •Yul.f'L7rd�ay HOMEOWNER LICENSE EXEMMOV Pltsw lariat Date �3 Job Location odF /�luson Sa•Z. SG/e„ Mf3 01Cr j Home Owner Address 9' h1&5ovf Sa•. SS lP„ MA ©r9� Home Ownt Telephone �r 7; '-- 7 q4-0507 Preaed mailing Add<see.)9 /"la soh Sd. S a/«« /MH 01970 The current exemption of"Homeowners"was extended td inchtdep owner-occupied dweUlno of Mo Units or leas and to allow such homeowners to engage as individual for him who dose not possess a ffeasse,Provided that the owner acts as suptvisar. DEFINITION OF HOWOWNER Person(s) *be owns @ Pared o[land on which he/she raids@ or intend@ to resider on which them is, or is intended to ben a one or two ramify dwelling, attached or detached structure accessory to such use and/or farm structure. A Person who constructs more than one home in a two year period shall not be considered a homeowner. Such "homeowner"shall submit to the Building OQlcial,on s form acceptable to the Building Official, that he/she be responsible for all such wort performed under the Building Permit The undersigned "homeowner"assume responsibility for compliance with the Stu@ Building Code and other applicable bylaws and regulations. The undanigned "homeowner"certifies that helshe undentands the City of Salem SWIding Department minimum inspoctioe procedures and requirements and that hdshe Will comply with said procedures and requirements. HOMEOWNERS SIGNATLRk$ � APPROVAL OF SUILONG DiSPECTOR Ste Other side far state cafe