18 NORTHEND AVE - BUILDING INSPECTION (3) RECEIVED 10/28/2014 13:21 9785323239 DR PATRICIA HEBERT
10/28/Z014 12:23 9787409846 CITYOF SALEM PAGE 01/04
1A- [ 1;K-0 S RECEIVED
=ate
Nt SER`1lCES
Che Comm°nwealth of NtassachusetFBoard oFBuilding Regulations and StanIMassachusetts State Building Code, 780r 2011Building Permit Application To Construct. Repair, Ren
One-or Two-Fnmily Dwelling
t\^ Tltis Section For Official Use Only
t J Building permit Number Date.Appl
�J d . ,r.�.✓ l Date
Duilding Olticial(Print Name).
SECTION I:SITE INFORMATION`
I. Pro er Address: 1.2 Assessors Nlap& Pnrcel Numbers �0
o Parcel Number
Mop Number
I,I a Is this an acce ed street?yes k' no�) 13 Zoning Information: ('hvo K-3 037Y-Pile Sind Dimensions:I.4 Properly /DO fee/ .
Zoning P st ict Proposed Uri~
Cot Area(sy tl) Frontage{It�_
1.5 Building Setbacks(R) Rear Yard
Front Yard Side Yards
provided Required Provided
\ Required Provided Reyuind
1.6%Vldcr Supply:(M.G.L c.40,§54) 1.7 Flood Zone Infarmatlan: 1.8 Sewage Disposal System:
Zone: outside Flood Zane? Munleipnl❑ On site disposal system ❑
Public O Private Cl Check tf n0 .
SECTtON2: PROPERTY OwNERSNIP,
2.1 OsvnertofRetlydSp� IQM ./}, 0j4j0
to-sins 1 T'P�o t`e
�1me(Print) City.Smte,ZIP —
1
Telephone Email Address
No.and Strcct
SECTION 3:DESCRIPTION OF PROPOSED WORK?(check all that apply)
NewConsmtclian ErlmingBuilding❑ Owner-Occupied ❑ Repairs(s) O Altention(s) ❑ Addition ❑
Detnelition ❑ Accessory Bldg.❑ Number of Units_
Brief Other ❑ Specifj':
BriefDcscripti°nof Proposed WorO:_
SECTION 4:ESTIi<IATED CONSTRUCTION COSTS
Estimated Costs: Official Use Only
Item Labor mid Materials
.S I. Bull rig mit g Per Fee:S Indicate how fee is determined:
1. Building
❑Standard City(Town Application Fee
2. Flectriad $ ❑Total Project CosP(item 6),t multiplier x
7-Plumbing
?}Q ther Fees: S
$
4.`Icchmtical (HVAC) $ List:
5.PlvYbanical (Fire $ 'total All Fees:$
Su ressiun) Clteck No.,Check Amount: Cash AVn°nn t:_
0-3
6.Tulal Project Cost $ I YbO. Yr ❑Paid in Full ❑Outstanding Balance Due:
RECEIVED 10/28/2014 13: 21 9785323239 DR PATRICIA HEBERT
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SECTIONS: CONSTRUCfIONSERVICES
5.1 Construction Supervisor License(CSL) ��
License Number :—Epirutiun UName at'CSL FielderList CSL'rypo(set belowr.Type escriptionNu. ;mJ Stttict U Unn9aieteddin a l0 35,Wn w, a.
R Restricted 11m1I Dwdiin
Nt NO=
City/Town,State,7_fl' RC Rool'm Colin
WS window and Sidin
SF Solid Fuel Burning Appliances
t insulation
�! Email address b Demolition
Talc hmme
5.2 f2egistered Home f mprovement Contractor(HIC) IIIC Rogis an Nn rrber Expiration Date
IIIC Compvmy Name ur Ii1C Registrant Name
Emuil address
No.aryl Street
Ci /-'r,wn State ZIP Tel one
SECPION 6:WORW EMW CONIPENSATION INSURANCE AFF[DAV1T(M.C.G G ISZ 91SC(�)',
Workers Compensoden Insurance affidavit must be completed andsu itted with this application. Failure to provide
this affidavit will result in the denial of the Issuance of the building permit
Signed AtTdavit Atmched7 Yes..........Cl No...........O
SECTION 7n:O W IYER AUTHO..RIZATIOH:TO BE COMPLETED W HEN-
OWNER'S AGENT OR CON TRACCbit Aims3FORBUILDINCPERM C
_(,6s Owner of the subject property,hereby authorize
t9 act on my behalf,in all matters relative to work authorized by this building permit application,
Dale
Print fhvnces Name(Electronic Signature)
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.
Print Dvmer's or, uthorittd Agent's Nome(L[Ittuunic Signature)
Date
NOTES:
I An Owner who obtains a building permit to do hisilier own work,or an,owner who hires an unregistered contractor
(not registered in the Home Improvement Contractor(H iC)Program),will LW have access to the arbitration
program or guaranty rand under NI.G.L.C. 142A. Other important information on the HIC Program can be found at
www.rim umv.' ca Information on the Construction Supervisor License can be found at www mass�Qv'dns
2. lvhen substantial wank is planned,provide the information b garage,a finished baserrient/altics,decks or porch)
Total fluor area 0% ft.) (includingg 4
Gross living area(sq.fQ Habitable room count
Number of fireplaces Number of bedrooms
Number of bathrooms Number of dccks(po
'type of hcmfig system Number of decks/pordmcs —
*rypeoraootiggsystem Cnelused Open
1. "Total Prglcct Square Fou�eb,sulms'tiuitcJ fo["'rutal Project Cost"
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10/28/�014 12:23 9787409846 CITYOF SALEM PAGE 03/04
CITY OF SALEM, MASSAaInEM
BUILDING DEPARTMENT
Ih� 120 WASMNGTONSTREET,YD FLooR
'TEi..(978) 745-9595
FAX(978)740-9846
KIMBERLBYDRISODLL
MAYOR TFIOMAS STYIERRE
DIRECTOR OF PUBLIC PROPERTY/BUILDING OCINSESSIONER
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 c40, S 54; Building Permit# is issued with the
i that the debris resulting from this work shall be disposed of in a properly licensed
condition t a g p
waste deposit facility as defined by MGL c 111, 5 150A.
The debris will be transported by:
(name of hauler)
The debris will be disposed of in:
(name of facility)
(address of facility)
Signature of a p# ant
Date
RECEIVED 10/28/2014 13:21 9785323239 DR PATRICIA HEHERT
10/28/2014 12:23 9787409846 CITYOF SALEM PAGE 04/04
CITY OF SAUK MASSAG�IUSETTS
)?iIJILDING D1:PAR'INIENf
a y #•' "! 120 WASHINGTON STREET,3ry"FLUOR
j�• 'r.,,.x'r�� TEL.(978) 745-9595
FAx(978) 74C-9846
KINMERLEY DWSCOLL TI-COMAS SMPIERRB
MAYOR DIRECTOR OF PUBLIC PROPERTY/BUILDING C'.010vUSSIONER
HOMEOWNER LICENSE EXEMPTION
PLEASE PRINT:
Date_
Job Location_ lb'Nnrl�tFvf /a1�
Home Owner Address
Present Mailing Address
The current exemption of"Homeowners" was extended to include owner-occupied dwellings of two
Units or less and to allow such homeowners to engage an individual for hire that does not possess a
license, provided that the owner acts as supervisor.
DEFINITION OF HOMEOWNER
Person(s)who owns a parcel of land on which he/she resides or intends to reside, on which there is, or
is intended to be, a one-
or two-family dwelling,att
ached or detached structures accessory to such use
and/or farm structures. A person who con
structs more than one home in a two year period shall not be
�� Official,on a form acceptable
" 11 submit to the Building 0
caner shall considered a homeowner. Such "homeowner" '
to the Building Official, that he/she be responsible for all such work pert rmed under the Building
Permit.
The undersigned "homeowner" assumes responsibility for compliance ith the State Building Code and
other applicable by-laws and regulations.
The undersigned "homeowner" certifies that he/she understand the Cit of Salem Building, Department
minimum inspection procedures and requirements and that he/she will c mply with such procedures
and requirements.
HOMEOWNER'S SIGNATURE d
APPROVAL OF BUILDING INSPECTOR
1 FT
A
J/
i �
11FT >
Deck 23FT
House