24 MONROE RD - BUILDING INSPECTION (2) � v.
s
� �
� I'he Commomvealth uf Massachusetis
� ,� � DoarJ of BuiWing Rrgulations and Standards ��TY
q•!y j Massachusrtts State Building Code, 780 CMR, 7'"cJition ��F SALEM
,�y� Rrvisrd Jurtnury
�,('1 l3uilding Permit Application To Construct, Repair, Renovate Or Demolish a l. ZonX
�\\J Onr-or T�vu-Familv Dwr!ling
1� This Sec[ion For OfTicial Use Onl
(,�'� Building Permit Number: Date Applied:
" ` J
(�� SignaNre• .
I)uilding Cummissioned Inspectorof Buildinya Date
, SECTION 1: SITE INFORMATION
1.1 Property Addres�: 1.2 Asaeason Map d� Parcel Numben
aH ,�.o�rw.c ,�.�a-.�
I.I a Is Ihis an accepted streot?yes_ no Map Number Poroel Number
1.3 Zonlag Inlormatloo: I.J Property Dlmemlona:
Zuning Distric� PmposeJ Use Lm Area(sy Il) Fronwge(It)
1.5 Bu�IdingSetbacW(ft) � _ '
From Yard SiJe Yard� Rear Yard '
Reyuiml Provided RequircJ Provided Requircd Provided
1.6 Waler Supply:(M.G.L c.40,§54) 1.7 Flood Zone lnformatloo: 1.8 Sewage Dbpoaal Syatem:
Zone: Oulside Flood ZoneT
Public❑ Private O Check if es0 Municipal O On eite disposel system O
SECTION 2: PROPERTY OWNERSHIP�
2.l Owner�of Record: f
�ON�Y �iC�Atu� 07� Y�'1���� �-C!✓�i��
Nume(Prim) � Address for Service:
Si�Snaturc Telephone
SECTION 3: DESCRIPTION OF PROPOSED WORK=(c6«k all that apply)
New Construction❑ Existing Building❑ Owner-Occupied ❑ Repairs(s) ❑ Alteration(s) ❑ Addilion
. Demolition ❑ Accessory Bldg.O Number of Units Other ❑ Specify:
Brief Description of Pmposed Work': �^ �.P.�.�4i�� ..7� Can+,�-2✓..�� f-rv� h
� � Cc,.���`Lecic� (SrktLc.
SECTION J: ESTIMATED CONSTRUCTION COSTS
Item Estimated Custs: Q(ncial Use Only
Labor and Materials �
I. E3uilding 5 6Sb�j. �.,, �� Ouilding Pertnit Fee:S Indicate how I'ee is determined:
2. Electrical 5 7��,W �Standard Ciry/Town Application Ftt
�Total Project Cost (Irem 6)s multipJier s .
). Plumbing 5 - puv� �� 2. Other Fees: S }� �
�. Mechanical (FIVAC) S List: �� ( )
5. Meehanical (Fire S
Su ression Tolal All Fnes:S
Check No. Check Amount: Cash Amount:
6.Tofal Project Cosf: S ��G �. (,, O Paid in Full O Oulstanding Balance Due:
�� � �.��.�w�
� .
� , ,
tiECTtOIV S: CONSTRUCTION SERVICES
S.1 Licen�ed Cunstructlon Supervisor(CSL) � 27 � 3 3 �f ( L
I�� l fe �Im� � I.iccnseNuml�er ftpiraiiunDate
N�une ul'CSL•IIuIJer /� ty(.k I.ist CSL"PYpe Ixe belowl
�Q �o/li'U �h'BS�iLI.�
�.�' `� IXxti lion
AdJrev � . UnrestricteJ u to 75.000 Cu.Ft.
. �'�—�� R Reslricted I&2 Famil Uwallin
Signawrc '! M Maw Onl
� ���sLy� RC Residemial Radin Cuvcrin
�����P��� WS RexiJential WinJowandSidin
SF ResiJenlial Sulid Fuel Bumin A li�nae Ins�allu�iun
D Residrnlial Demoli�ion
3.2 Regbtered Home Improvemeot Contractor(HIC) � Z$�j �j Z
' /' ...la 1�+ .
FIIC Com�y N�une ur HIC R gistmnt N;une Regis�rotiun Number
� s, Qoarl3 'rL.s�-r r� /f"��. ar f r3 Z /d�/j2
ndJress C "-n� �L- �� �/'�y-G�(/�/l 1Gapir�a�ionDale
Siyn•rture Tclephune
SECTION 6: WOIIKERS' COMPENSATION INSURANCE AFFIDAVIT(M.G.L.c. 132.§ 2SC(6))
Workers Compensation Insurance afFdavit mus[be completed and submitted with this application. Failure to provide
this affidavit will result in the denial of the(ssuance of the building permit.
Signed Affidavit Altached7 Yes ..........O� No........... 0
SECTION 7a:OWNER AUTHORIZATION TO BE COMPLETED WHEN
OWNER•S AGENT OR CONTRACTOR APPLIES FOR BUILDING PERMIT
� , as Owner of the subjec[property hereby
authorize to act on my behalf, in all matters
relative to work suthorized by this building permit application.
Si aturcofOwner Date
SECTION 76:OWNER�OR AUTHORIZED AGENT DECLARATION
� �,,,� ,as Owner or Authorized Agent hereby dec�are
that the statements and inf rtnation on the foregoing application are lrue and accurate,to the best of my knowledge and .
behalf.
'C�,.- 1 y `^�t
Prinl Name � �� �
��Q � � f
Signature ol'Owner or Authorized Agent Date
Si ed under the ains and naltie�o! 'u
NOTES:
I. An Ownrr 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 Contraclor(HIC)Program),will nu have access lu the arbitration
program or guaranty fund under M.G.L.c. 142A.Other importanl informalion on the HIC Program and
Construction Supervisor Licensing(CSL)can be found in 780 CMR Regulations I I O.R6 and I IO.RS,resptttively. �
2 When substanlial wor4c is planned,provide the inf'ormation below:
Total tloors arcu(Sq. Ft.) (including garage, finished bazemendattics,decks ur porch)
. Gross living area(Sq. Ft.) Habitable room count
Number oF fireplaces Number of'bedrooms
� Number of bathroums / Number oYhalf/balhs
Type of heating system Number of Jecks/porches
Type of cuoling system flnclosed Open
3. "To�al Project Syuare Foo�age"may be substituteJ for"To�al Project CosP'
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N/F N�F
N/F �`'
WILLIAM HASKELL JOHN A. &
GRETA P. RICHARDS JUDITH K. HAMERSTROM
IRON ROD
SET
iRON ROD N59'S9 9"W "I CERTIFY THAT AN ACTUAL ON GROUND
sEr ��
� STONE M�AIl- �� ' INSTRUMENT SURVEY WAS PERFORMED ON '
sHEo ` ' APRIL 26, 2006 AND THAT THE RESULTS
STAKE �c NAIL ` ARE SHOWN HEREON."
SET _ �,�..(�-tI /'`.`�_ ��� .
LOT 6 N ,.,�
_ � 7420� J. F cRouNo ;-- - RALPH W: REID P.LS. �,
. POOL
; N�F
STAKE dc NAIL GEORGE B. &
STAKSE Na� sEr LILLIAN M. TASSINARI
N GARAGE
N/F `� ' GRAPHIC SCALE
RICHARD W. & o o N o ;� ",�„
JOANNE M CARON 1� � o o' ; ��'�`���,� s° o +° s° '° °°
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STAKE de NAIL 1 STORY � {1a.<y4� �: � � �ET )
SET WOOD , � 1 inch = 20 ft r
�24 STAK SE NAIL i � �,¢� ' a� -� . � ..
� J I ''� SALEM , � ` MASSACHUSETTS
STAKSE NA�� ' PLAN OF LAND PREPARED FOR:
. PK "A" = JONATHAN BEDARD
o � N �T
u
• IRON ROD PA � �' 24 MONROE ROAD
�T � STONE DRI WAY �
��6•19' WA�` � MAP 31 LOT 194 -
R=840.00' , P SE �L �
REID LAND SURVEYORS ,
24 MONROE RO 3s5 CHATHAM STREET �� "
AD LYNN, MASSACHUSETTS
S06-014
'�, RWR/LTS DATE: APRIL 26, 2006 SCALE: 1 " = 20'
� '
� - - - -
,
.,,. .,..�,* . �
Z ' ..
��
N/F N/F
GRETA P /ICHARDS �NILLIAM HASKELL J�HN A. &
JUDITH K. HAMERSTROM
IRON ROD �
� SET {
tRON Roo N59'S9'�9"W "I CERTIFY THAT AN ACTUAL ON GROUND
SET ��
� STONE WALL 65.00' INSTRUMENT SURVEY WAS PERFORMED ON I
sr+Eo APRIL 26, 2006 AND THAT THE RESULTS
STAKE h NAIL "` ARE SHOWN HEREON."
SET LO T 6 N � -���'2.�-��.�
- N 74ZO� S F cRouNo - " RALPH W. REID P.LS.
tO • . POOL I
' N/F
STAKE dc NAIL GEORGE B. &
STAKE dc NAIL �T LILLIAN M. TASSINARI
SET
N GARAGE
N/F w , w �, GRAPHIC SCALE
RICHARD W. & o o N o �,,,,'��
JOANNE M CARON i� o N o� � ��'••���°°`� � o ,o so +a eo
0
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STAKE Ac NAIL� � 1 STORY � 1�2;� ��s � � �� �
SET N�OD � �� 1 inch = 20 ft
/24 STAKE dt NA�L ' '�,� ��a
SET
� SALEM , MASSACHUSETTS
� �
STAKSE N,�� � � � PLAN OF LAND PREPARED FOR :
PK "A" JONATHAN BEDARD
o � N ser
W
'R°" R°° P"�° �' 24 MONROE ROAD
SET ) STONE DRI WAY
��6•� 9' WALL s PK N IL . MAP 31 LOT 194
R=B40.00' � sE
=� REID LAND SURVEYORS
24 M �NROE RO � 365 CHATHAM STREET ��
Ap LYNN, MASSACHUSETTS
S06-014
'� RwR/�rs DATE: APRIL 26, 2006 SCALE: 1 " = 20'
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