24 OCEAN AVE - BUILDING INSPECTION (2) The Commonwealth of Massachusetts
Tfl
Board of Building Regulations and StandardsCITY OF
Massachusetts State Building Code, 780 CMR SALENI
Building Permit Application To Construct, Repair, Renovate Or Demolish a Revi.md:Nur 2011
One-or Two-Family Dwelling
This Building Permit Number: Section For OtliciM Use Only :.
Dot Plied:
Building Official(Print N:une) l J
Sil,nature ` Date
1.1 Property Address: SECTION I.SITE INFORMATION
1.2 Assessors Map&Parcel Numbers
I.la Is this an accepted street?yes no bfap Number Parcel-- arcel Number
I.J Zoning Information: _
1.4 Property Dimensions:
Zoning D— is�— proposed Ua�—
Lot Area(sy ft) Frontage(R)
1.5 Building Setbacks(ft)
Front Yard Site Yards
Provided Re
Require) Provided Rear Yard
Required aired
y Provided
1.6 Water Supply;(M.G.L c.40,§Sd) 1.7 Flood Zone Information:
Public)( Private❑ Zone: _ Outside Flood Zone? 1.8 Sewage Disposal System:
Check ifyes❑ Municipal❑ On site disposal system ❑
2.1 Owner'of Record:
SECTION2: PROPERTYOWNERSHIP�
-
0/me(
N�hme(Print)
Crty,State,ZIP
—� { Q_ `1\
No,mid Street dd t
Telephon Email Addres�
SECTION J: DESCRIPTION OF PROPOSED WORK'(check all that apply)
New Construction ❑ Existing Building❑ Owner-Occupied Repairs(s) ❑ Alteration(s) ❑ Addition ❑
Demolition ❑ Accessory Bldg.❑ Number of Units ?�
Brief Description of Proposed Work': `L `..;_� ( C ether ❑ Specify:
s
SECTION a: ESTIMATED CONSTRUCTION COSTS
Item Estimated Costs:
Labor and Materials Official Use Only
I. Building S U , I. Building Permit Fee:$ Indicate how fee is determined:
2. Electrical $ Ut� •❑Standard City/To vn Application Fee
J. Plumbing $ _ Total Project Cost"(ftem 6).x multiplier x
d. MechanicalMechanicalOther Fees: $(FIVAC) $
5. Mechanical (Fire List:
Su ression) '$ "fatal " Fees S
6. 'Fntal I'rnject Cush .$ CVO
l Check No._C'heck Amount: Cash Amount_
Ut•°' 'V'l! ❑Paid in Full ❑l7utstanding palance Due:
SECTION 5: CONSTRUCTION SERVICES
5.1 Catstructioo Supervisor License(CSL) _--
----- Expiration Date—
License Number
Nome of CSL Holder List CSL Type(see below)�-
.type -Description
No.and Street U Unrestricted Buildin s u to 35,W0 cue It.)
R Restricted 1&2 Family Dwellin
M Mason
Cityfrown,State,ZIP IZC Rootin Covering
WS Window and Sidin
SF Solid Fuel Burning Appliances
I Insulation
-re Email address D Demolition
Tole hone
5.2 Registered tlome Improvement Contractor(HIC) tllC Registration Number Expiration
I liC Company Name or HIC Registrant Name
Email address
No.and Street
Tele hone
Ci /Town,State,ZIP
'COMPENSATION INSURANCE AFFIDAVIT(MIG,L.C. 152.Q 25C(
SECTION 6:WORKERS
ith this application. Failure to provide
Workers Compensation Insurance affidavit must be completed and submitted w
this affidavit will result in the denial of the Issuance of the building permit.
....No.. .
Signed Affidavit Attached? Yes ..........❑ ""❑
AUTHORIZATION PERMIT
BE COMPLETED WHEN
SECTION ,a:OWN ' IT
OWNER'S AGENT OR CONTRA "
CTOR APPLIES FOR BUILDING PER
1,as Owner of the subject property,hereby authorize
tj act on my behalf,in nit matters relative to work authorized by this building permit application.
Date
Print Owner's Nmae(E ectromc tmm
SECTION 7b:OWNEW OR AUTHORIZED AGENT DECLARATION
es of perjury that all of the information
By entering my name below,I hereby attest under the pains and penalti
contained in this application is true and accurate to the best of my knowledge and understanding.
Date
Print Owner's or Authorized Agent's Name(Electronic Signature)
NOTES:
I. An Owner who obtains a building permit to do his/her own work,or an oml,will l B vet
access tottthe arbhr-gistere�t ontractor
(not registered in the Home Improvement Contractor(HIC) Program),
program
or guaranty fund s_ ,t_ i oc;t information on er the Constru tioonhSupervisor Liceer importantfnse can be foundormation on the wow I» s"t_ 'b`/'Itrs and at
When substantial work is planned,provide the infori,cf o�tn�l0g �ge, finished basement/attics,decks or porch)
"total tloor area(sq. ft.) Habitable room count
Gross living area(sq. RJ_____—.---- Number of bedrooms
Number of fireplaces Number of b:df/baths
Number of bathrooms Number of decks/porches
'type of heating system_�— Enclosed_.__.__Open
Type of cooling system
}, "Total Project Square Footage"may be substituted for`Total Project Cost"
I
I
QTY OF SALEM, MASSAC IUSETTS
/3 BUILDING DEPARTMENT
120 WASHINGTON STREET,3� FLOOR
\ � TEL. (978) 745-9595
F
KIMBERLEY DRISCOLL FAX(978) 740-9846
MAYOR THOMAS ST.PIERRE
DIRECTOR OF PUBLIC PROPERTY/BUILDING CO MSSIONER
HOMEOWNER LICENSE EXEMPTION
PLEASE PRINT:
Date { /
. Job Location F, C J L-�/�,� ✓� j�
Home Owner Address
Present Mailing Address C C�r1s�
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, 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 understand the City of Salem Building Department
minimum inspection procedures and requirements and that he/she will comply with such procedures
and requirements.
HOMEOWNER'S SIGNATURE
APPROVAL OF BUILDING INSPECTOR
CITY OF S.u.Em) -1SSACHUSETI'S
i i3UtLDN,GD EPA R1N 0NT
i` 130 WASHCYGTON STREET, 310 FLOOR
TEL (978) 745-9595
F-LX(978) 740-9M
KI3BERLEY DRISCOLL
AILAYO t TFtoaLiSST.PtERRB
DntECToa OF PUBLIC PROPERTY/81:I1.0LNG COJWt5SIONER
Construction Debris Disposal Affidavit
(required for all demolition and renovation work)
In accordance with the sixth edition of the State Building Code, 730 CAQR section It 1.5
Dcbris, and the provisions of INIGL c 40, S 54;
Building Permit k is issued with the condition that the debris resulting from
this work shall be t 11, S I SOA. disposed of in a properly licensed waste disposal facility as defined by INIGL c
The debris will be transported by:
1
(name et auler)
The debris will be disposed of in
(narne of facility)
(address of facility) U
(late