8 OAK VIEW AVE - BUILDING INSPECTION ,
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The Commonwealth of Massachusetts
0 IUR
t Board of Building Regulations and Standards
I r ,,, Ml'Nlt'IP:V.III
L.' 5 Massachusetts State Building Code. 780 CMR, 7 edition
1 til'.
Building Permit Application To Construct, Repair. Renovate Or Demolish a Izrri,rJ./,ntuau,
DOne- or Tito-Fumilr Duelling
\ This Section fficial Use Only
Building Permit N tuber: D ite Applied:
Signatwe:
Building Conuniseionei Inspector of BuN du gs Date
SECTION 1: SITE INFORMATION
1.1 Pr k U erty Address: 1.2 :\s es.ors Map & Parcel NumI
_Qc i e* w r4-U2- 1 F f
.la Is This an accepted street'! yes nn bla_ P Nunthcr Parcel Numher —
1.3 Z ning Information: 1.. Pr ert tmensions: a
-_..__- - -�'-FJ�.t _=.-
Zoning p;arict Proposed Use. Lot A1ea(sy ii) Fruniage Ut)
�_i.e .ems iluurii��Jl�vi!l Is (fir _ __ 11
j—-- �Front Yard Side Yards Rear Yard __ !
! Required l Provided Required Provided Required P1m ded
1.6 Water Supply: (M.G.L c 40, §54) 1.7 Flood Zone Information: 1.8 Sewage Disposal System:
Zone: Outside Flood Zone?
Puhhe Private❑ — Municipal, T On site disposal rystem ❑
Check if yes❑ _ JI
SECTION 2: PROPERTY OWNERSHIP'
2.1 nor of Recur
t, L�—_A_ t2rn � pQk ,4v¢-
Address for Service: —
Sigramre Telephone
SECTION 3: DESCRIPTION OF PROPOSED WORK'(check all that apply) J
Ncr:Construction Cl Existing Building ❑ Owner-Occupied ❑ Repairs(s) ❑ Altertionl;) AJdili� n ❑
--
Demolition ❑ Accessory Bldg. ❑ Number of Units__ Other ❑ Speciiy:_ _ --- - _
--- - -'i
^rief Cesc,rptlnn of Proposed Work':— 0�,X s,Fa,/ -,—._sLgS LP_-huat.—r, ca
I
�- SECTION 4: ESTIMATED CONSTRUCTION COSTS
f Item
-__ ----- -----Estimated Costs: ------ Official Use Only
(Labor and Materials)
I. Building $ tA40.Oc7 I. Building Permit Fee: $ Indicate how fee is deleinon.
`' ❑Standard City/Town Application Fee
2. Electrical $ ❑Total Project Cost (Item 6) x multiplier x
3. Plumbing $ '. Other Fees: $
a. Mechanical (HVAC) $ List:
5. Mechanical (Fire $
� Suppression) Total All Fees: $
Check No. Check Amount: Ca,h Amount:
0. 'rotal Project Cost: $ / 00V '00 0 Paid in Full 0 Outstanding Balance Due:_--__.
SECTION 5: CONSTRUCTION SERVICES
5.1 Licensed Construction Supervisor (CSL)
License Number Expiration Datc
Nance of CSL- Ifolder
List CSI_Type(9ee heluu)
AJJress Type Descri i(ion
C Unrestricted ut i to 3i,(A)O Cu- Ft.)
R Restricted 1&2 Family Duelling.
Signature ..\1 N:uonry Only
RC Residentiai Rootine Coxrnne
Telephone \\'S K::eidenual Window .t SiJni� _
SF Residential Solid Fuel liurmn" \ lwnca 1111111111011.11
D Re.identiul Demolition
5.2 Registered Home Improvement Contractor(HIC)
Ii1C Company Name or HIC Registrant Name Registration Number --
Address
_._.__._... _. Expiration Date
Signatue Telephone I --
SECTION 6: WORKERS' CONIPENSA'TiON 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 ._... .... O
SECTION 7a: OWNER AUTHORIZATION TO BE COMPLETED WHEN —�
OWNER'S AGENT OR CONTRACTOR APPLIES FOR BUILDING PERMIT I __
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.
i
Sig,;ture. of Owner Date
SECTION 7b: OWNEW OR AUTHORIZED AGENT DECLARATION
1 , as Owner or Authorized Agent hereby declare
that the statements and information on the foregoing application are true and accurate, to the best of my knowledge and
behalf.
Print Name
Signature of Owner or Authorized.Agent v Date
(Si)!ned under the 2ains and penalties of edu )
_ NOTES:
L 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 fund under M.G.L. c. 142A. Other important information on the HIC Program and
Construction Supervisor Licensing (CSL) can be found in 780 C'MR Regulations I IO.RG and I IO.RS. respectively.
2. When substantial work is planned, provide the information below:
Total floors area(Sq. Ft.) (including garage, finished base mendattics, decks or porch)
Gross living area (Sq. Ft.) Habitable room count _
Number of fireplaces Number of bedrooms _
Number of bathrooms Number of half/baths
Type of heating system Number of decks/ porches j
'Type of cooling system Enclosed Open _
3. "Total Project Square Footage- may be substituted for "Total Project Cost"
GLORAL ASSOCIATES
REGISTERED LAND SURVEYOR • REGISTERED Ph'OFESSIONAL F-NGIA'i f=R
24 .VEPNON ST, WAKEFIELD, MA. 0/880 T.• A6-9345 FAX. 24 -9338
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50.0 s
LOT. 159
5,600 S.
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THIS IS A TAPE SURVEY BASED ON SURVEY MARKEERS OF OTHERS lAH� SUAVE��R
AND THIS PLAN WAS DRAWN FOR MORTGAGE PURPOSES ONLY, THIS
PLAN WAS NOT MADE FOR: RECORDING PURPOSES, DEED DESCRIPTIONS,
' CONSTRUCTION,VERIFICATION OF It DIMENSIONS, BUILDING OFFSETS, "-
F€NCES OR LOT CONFIGURATIONS, ONLY A PRECISE INSTRUMENT
-.SURVEY CAN DETERMINE ALL OF THE ABOVE. MORTGAGE INSPE('. PION PLAN
THE PREMISES SHOWN ON THIS PLAN ARE NOT LOCATED WITHIN THE IN
FLOOD HAZARD ZONE AS DELINEATED ON THE MAPS OF THE
COMMUNITY, 250i(D2 0005 y e..5_85 LEM �ti'IASS.
I HEREBY CERTIFY THAT THE BUILDINGS)SHOWN ON THIS PLAN ARE - -
APPROXIMATELY LOCATED ON THE GROUNDS AS SHOWN THEREON AND OWNED BY
THAT THEY CONFORM TO THE ZONING AND BUILDING LAWS
(DIMENSIONAL REOUTREMENTS) OFTHE CITY OF SAL:M FRIC AND MARY CONNOLLY
WHEN��CONSTRUCTED AND TO RESTRICT'70N5 ON RECORD.
SCALE 1 20' DALE I ��- _G5
_ 13._.-
SfGNATLIRE DATE
CITY OF SALEm
PUBLIC PROPERTY
DEPARTMENT
K1101FJIbY n�w•ry L
Vwrot 130 WA SHIPAGT M Sri•
c•,eM.NASfAd/l•56l'IS 01970
T1:978-735-959S• FAX.9747-60.984
HOMEOWNER LICENSE EXEIMMON
Please Print
Date
Job Location k U< rww A C.
Home Owner Address ocucvL2+.. AyA-
Home Owns Telephone at q5 140- a.'7 3 3
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 who,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 intendi to reside, on
which there is, or is intended to be, a one or two family dwelling. attached or detached
structures accessory to such use and/or farm structures. 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 Official, on a form acceptable to the Building
Official, that he/she 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 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 and requirements:
HOMEOWNERS SIG IIATL'RE
APPROVAL OF BUILDING INSPECTOR
See other side for state code
CITY OF SALEM
S
n_�&i PUBLIC PROPRERTY
JU 1,� j
DEPARTMENT
i%lj� Fit :
d 12C A AY]IN,,.,IN5 IN I:IT # ;\I I M, \1
W'8-74i-');96 4 1:\X: 978_174C�9S46
— Construction Debris Disposal Affidavit
(I-CLILliled ['or all demolition and renovation work)
In accordance with the sixth edition of the State Building Code, 780 Crv1R section 111.5
Debi-is, and the provisions of MGL c 40, S 54;
Building Permit ft - is issued with the condition that the debris resultin,u from
this work shall be disposed of in a properly licensed waste disposal facility as defined by MGL c
I 11. S I 50A.
The debris will be transported by:
i name of liaLl(er)
'I he debris will be disposed of in
(name of facility)
laddress of I'aLllilV)
signature of permit api)[ILaIlt
-7—
date
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