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6 NURSERY ST - BUILDING INSPECTION
The Cummonwcallh of Massachuscits Town of Board of Building Regulations and Standards Massachusetts Slate Building Code. 780 CMR. 7'a edition Building Budding Permit Application To Construct. Repair. Renovate Or Demolish a MEMO One. or Tvo-Funufr Du efftng This Section For Official Use Onl Budding Permit Number Date Applied: 2 �\ Signature: / Budding C stoner Insprctar of Buildings Date SECTION I: SITE INFORMATION 1. Prgytrty V f Sys: C 1_ 1.2 Assessors Mop i Parcel Number N J'� M Number Parcel Number I.I a Is this an uce t street?yes ✓no Map 1.3 Zoning Informstloa: 1.4 Property Dimensions: Zoning District Proposed Use La Area(sq R) Frontage Itt) 1.5 Building Setbacks(n) Front Yard Side Yards Rear Yard Required Provided Required Provided Required Provided ' 1.6 Water Supply:(M.G.L c.40.154) 1.7 Flaad Zoo0 Informollon: I.g Sewage Disposal System: Zone: _ Outside Flood Zone? Municipal D On site disposal system D Public D Private D Check if SECTION 2: PROPERTY OWNERSHIP' 2.1 Ow Q rl',o�f.RPawr ,) Irs-�r C� �ZAddress fw Service: 1� U— 6v� � Signature relephona SECTION J: DESCRIPTION OF PROPOSED WORK'(check all that apply) New Construction D Existing Buildin Owner-Occupied Repain(s) Alterson li (s)� Addition D pemolition D Accessory Bldg.D Number of Units \ Other D Specify: Brief Description of Proposed Work': e L SECTION 4: ESTIMATED CONSTRUCTION COSTS Estimated Costs: OAlclal Use Only Item Estimated and Materials 1. Building f 1. Building Permit Fee: f Indicate how fee is determined: O Standard City/Town Application Fee 2 Electrical f O Total Project Coss'(Item 6)a multiplier x. ) Plumbing f 2. Other Fees: f 4. Mechanical (HVAC) f List: S Nechantcal tFire f Total All Fees: f Su remon Check No. _Check Amount: Cash Amount: h Total Project Cost f 1 O I tf 00 D Patd in Full 0 OuNiandtng Balance Due: SECTION 3: CONSTRUCTION SERVICES 5.1 Licensed Construction Supervisor(CSL) ., • License NumRr Espnarron Date Nyot of CSL ItplJer Lr.t('51. Type hoe below( AJJress '~ HDRcsiJential Description stncted u to)3,000 Cu. Ft. cted IA2 FamilyDweller 5itr4ture entTelephone ntial Sohd Fuel Bumm A Trance Installation Demolition 5.2 Registered Home Improvement Contractor(HIC) HIC Company Name or HIC Redistrant Name Registration Number Address Expiration Due Signature Telephone SECTION 6:WORKERS'COMPENSATION INSURANCE AFFIDAVIT(M.G.1_e. IS2.I 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 AIIWavii Artachesl7 Yes.......... O No...........O SECTION 7n:OWNER AUTHORIZATION TO BE COMPLETED WHEN OWNER'S AGENT OR CONTRACTOR APPLIES FOR BUILDING PERMIT 1, as Owner of the subject property hereby authorize to act on my behalf,in all matters relative to work authorized by this building permit application. Si arm of Owner Date ,, SECTION 7b:OWNEW OR AUTHORIZED AGENT DECLARATION I, M�t Cke te- T I t Z G-- f i�- ,as Owner or Authorized Agent hereby declare that the statements and inform tion on the foregoing applicationare true and accurate, to the best of my knowledge and behalf. ,/( J(� CkQ LQ I Zc�' t d� Pr, Nm`v, F Signaeue of owner or Authorized Agent Date (Signed under the gains and penalties of NOTES: 1. 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 gg have access to the arbitration program or guaranty fund under M.G.L. c. 1 d2A. Other important information on the HIC Program and Construction Supervisor Licensing(CSL)can be found in 780 CMR Regulations I I0,R6 and 110.R5. respectively. 2. When substantial work is planned,provide the information below Total floors area(Sq. Ff.) (including garage. finished basement/a"ics•decks or porch) Gross living area(Sq. Ft.) Habitable room count Number of fireplaces Number of bedrooms `'umber of bathrooms Number of half baths Type of heating system Number of decks porches Ts pe of cooling system Enclosed Open 1 "Total Project Square Footage"may he suh.tituicd for 'Total Project Cost' CITY OF S.UF. N1 PUBLIC PROPERTY DEPARTMENT iufotLfY••_...-.v. Wrw 170 wAouMG"s"W"•su K Nwstuo&srrn 01f-0 M r.5.74s-gs".FAX 175-74-e64 HOMEOWNER LICENSE EXEMPTION Plesse "I Dan DLA i Job Location N U Y S-� �k Horne Owner i►ddress urc -40-ly CA Homo Owner Telephone 771 --' L"- present Mailing Addraa t- C yr rC17 l �r� i n t o n n or�� The current exemption of"Homeowners"was extended to include owneroccupied dwellings of two Units or less and to allow such homeowners to engage an individual for hire who.does not possess a license,Provided that the owner acts w supervisor. DE,FINMON OF HOMEOWNER which h Persons) who owns a parcel of tow on resides or intends to reside. on which there is, or is intended to be,a one or two family dwellins attached or detached. structures accessory to such use and/or farm structures. A person who constructs more than one home in s two year period shall not be considered a homeowner. Such .homeowner"shall submit to the Building Official,on a forth acceptable to the Building Official, that he/she be responsible for all such work performed under the Building Permit The underaigned "homeownee assumes responsibility for compliance with the State Building Code and other applicable by-laws and regulations. The undersigned "homeowner"certifies that he/she understands the City of Salem Building Department minimum inspection procedures and requirements and that he/she will comply with said procedures an//d requirements. qq-�� HOMEOWNERS SIGNATURE- `� `"J`�" '� - ��- .aPPROVAL OF BUILDING INSPECTOR See other side for state code 4 CITY OF SALEM PUBLIC PROPRERTY DEPARTMENT I_'0 W.,,I II\G:ON$1'N LET *S.\I l'rl:978-'43.9595 • 1:.ts:97a•7449846 Construction Debris Disposal Affidavit (required Our all denwlition and renovation work) in accordance with the sixth edition of the Slate Building Code, 780 CMR section 111.5 Debris, and the provisions of MGL c 40, S 54; Building Permit N _ _ is issued with the condition that the debris resulting from this work shall he disposed of in a properly licensed waste disposal facility as defined by MGL c t 11. S 150A. The debris �oon � �will be transported by: L i� �j W P�� lr(' C✓a� WO1�( v (name of hauler) The debris will be disposed of in (name of aci ny) (addreii W 11 1111y) r signature or Ilerilllt applicant slate Jnofficial Property Record Card Imp://salenLpatriotproperties.comtRecordCard.asp Legal Description Narrative Description of Property This property contains 0-112 acres of[arid no"classified as One Farnilyw%h s(n)Old Style style budding,built about ISM,having Aluminum exterior and Asphaa Shgl roof cover,with 1 unit(s►,7 roorr(s),4 bedroom(s),1 tmth(s),1 half bath(s). Property Images a It DbcWffna:This infamatim is believed to be correct but is subject to change and is not wanranteed. !of 10/18/2009 4:19 PM E ` R� § I�fIfYOYiir ,6(�,. f. Description of work—6 Nursery St December 7, 2009 • Heating - Install new gas boiler and baseboard heaters • Plumbing - Rough plumb for 2 baths, kitchen and laundry • Electrical -New service, outlets, lights and switches to code • Framing - Reconfigure 2"d floor to contain two bedrooms and bathroom • - Reconfigure I"floor to contain office, foyer, livingroom/dining room. Bathroom and kitchen • Close in side porch using existing roof • Move back door to kitchen wall—replaces existing window • Insulate - walls, 2"d floor ceiling • Plaster - Plaster lst and 2"d floor • Finish - Install doors window trim and baseboard • Windows - Install 25 replacement windows • Bulkhead - Install bulkhead and stairs replacing basement doghouse entrance Bath and kitchen finish not included- Additional permit will be submitted once plaster completed Estimated cost $101,400 ------------- r------ I I � I I I I I I I I 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 aA j- I I I I i I i �-------I I I ——————— I —-———————— —� I I I I I I I I I I I i I I I I I I i I I I 4T.'nJ9EA � � I I to Cy;p:ov4 b7 e,j I autharit:;havi-^9;: I CZT" off'SA-- ': LA":.A EAPPROVZDCCLEC f. a I I 'fFE AND LDOAT;ON OF FI== f.it. FIRF. PROTECTION CPACE�npr nO^�zCT J A I I � '"L1�`7 ACD!NSPECTiC.N�FOR OO!r!Fi.C��'-. . I I AC..c PdITHTNE FIRE CODE. I I I I i I I I I I I i I I I I I I I I I I I I I I I I B Vi2@D�P I I I � I ------- ------------ i I LIVING AREA 1114 sq ft 2268 — i q I -- 2268 N A N T� '' up 13'11 _ Kitchen _ . n cUP-_ � G i C t'^ 1 •.�V�Y�Yr�! i pining Room -T Bath n N W f Living Room I m _ N En(l'. UP �T Existing Q� m Porch o Foyer W Office m LIVINGAREA First Floor 1123 sq ft ' 23'4 9'6 13'10 --- — -- — .- 14 13'10 N � M � N Second Bedroom Bathroom — C) Pi in Ca LO M 0 Master Bedroom © M -dM. <j rre aK� 23' 23'4 -- — - LIVING AREA 710 sq ft 2nd Floor