49 OCEAN AVE - BUILDING INSPECTION (2) 00
The Commonwealth of Massachusetts
V Board of Building Regulations and Standards CITY OF
Massachusetts State Building Code, 780 CMR SALEM
Revised Mar 2011
Building Permit Application To Construct,Repair, Renovate Or Demolish a
One-or Two-Family Dwelling
This Section For Official Use Only
Building Permit Number: Date Applied:
Building Official(Print Name) S gna[ure Date
SECTION 1: SITE INFO T
1.1 Property Address: 1.2 Assessors Map&Parcel Numbers
E19 &C,4,1 mr
L 1 a Is this an accepted street?yes no Map Number Parcel Number
1.3 Zoning Information: 1.4 Property Dimensions:
Zoning District Proposed Use Lot Area(sq ft) Frontage(ft)
1.5 Building Setbacks(ft)
Front Yard Side Yards Rear Yard
Required Provided Required Provided Required Provided
1.6 Water Supply: (M.G.L c.40,§54) 1.7 Flood Zone Information: 1.8 Sewage Disposal System:
Public❑ Private❑ Zone: _ Outside Flood Zone? Municipal❑ On site disposal system ❑
Check if yes❑
SECTION 2: PROPERTY OWNERSHIP'
2.1 caner'of Re_co �,/9
�te� �� .�� V4� �il�� % 7
Name(Print) City,State,ZIP
AM& �✓�rA� 97� -39rG`17s ���1Dl�. «r,
No.and Street Telephone Email Address
SECTION 3:DESCRIPTION OF PROPOSED WORK (check all that apply)
New Construction❑ Existing Building❑ 1 Owner-Occupied ❑ Repairs(s)X I Alteration(s) ❑ Addition ❑
Demolition ❑ ALx I Other ❑ Specify:
Brief Description of Proposed Work': &41nUL vKtST:RV 9&Z6c- t XG&Al 1 L 14Yrc/ 9LZK
t i rl4 cc4fasTrC Pe7yjV,
SECTION 4:ESTIMATED CONSTRUCTION COSTS
Item Estimated Costs: Official Use Only
Labor and Materials
1. Building $ 1. Building Permit Fee:$ Indicate how fee is determined:
❑Standard Cityfrown Application Fee
2.Electrical $ ❑Total Project Cost'(Item 6)x multiplier x
3.Plumbing $ 2. Other Fees: $
4.Mechanical (HVAC) $ List:
5.Mechanical (Fire Suppression)
$ Total All Fees:$
Check No. Check Amount: Cash Amount:
6.Total Project Cost: ❑Paid in Full ❑Outstanding Balance Due:
�r--J P 1 L-, >c�
SECTION 5: CONSTRUCTION SERVICES
5.1 Construction Supervisor License(CSL) Cs, 688d95'-
1
,5T V I(8 V-{J(yA'-r License Number Ex ira ion Date
Name of CSL Holder v
List CSL Type(see below)
33yAgtG 51-&�r
No.and Street Type Description
PAM6! U Unrestricted(Buildings u to 35,000 cu.ft.
1S 0 alf23 R Restricted 1&2 Family Dwelling
City/Town,State,ZIP M Masonry
RC Roofing Covering
WS Window and Siding
SF Solid Fuel Burning Appliances
I Insulation
Telephone Email address D Demolition
5.2 Registered Home Improvement Contractor(HIC) j 76¢Fa
J K Cot/(/jT LOT o l UC HIC Registration Number xpi lion Date
TIC Company Name or HIC Registrant Name
_3)Y e��ar� 5mcarT -T3K3Y3VE nth. aA
No.and Sheet Email address
_OHaIy�3 Ah 6Q?a
City/Town, State,ZIP Telephone
SECTION 6:WORKERS'COMPENSATION 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..........)V No...........❑
SECTION 7a:OWNER AUTHORIZATION TO BE COMPLETED WHEN
OWNER'S AGENT OR CONTRACTOR APPLIESFOR BUILDING PERMIT
eS/1 l I,as Owner of the subject property,hereby authoriz / /511 t d7zn Z I- C
to act on my behalf in all matters relative to work authorized by this building permit application.
Print Owner's Name(Electronic Signature) Date
SECTION 7b: OWNER' 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 Owner's or A,t ized Agent's Name(Electronic Signature) Date
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 not have access to the arbitration
program or guaranty fund under M.G.L.c. 142A.Other important information on the HIC Program can be found at
www.mass. og v/oca Information on the Construction Supervisor License can be found at www.mass.gov/di)s
2. When substantial work is planned,provide the information below:
Total floor area(sq. ft.) (including garage, finished basementlattics,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
Type of cooling system Enclosed Open
3. "Total Project Square Footage"may be substituted for"Total Project Cost"
SJK Construction LLC
Building & Remodeling Contractor
License#'s
CS88095
HIC 170992
Ken Steinfield
49 Ocean Ave
Salem MA
6/16/12
Deck Proposal
• Remove existing deck , including decking, railings, stairs and sonna tubes
• Pour 2 sonna tubes and stair landing for new 4'x4' deck
• Construct deck with pressure treated framing, azek composite trim. Decking and railings to
be composite material (samples to be provided for selection)
• Provide new screen for existing entry door
• Purchase and install new gate hardware
• Price includes all labor and materials to complete the above scope of work, permits and
trash removal.
Total Price $4,200
Contractor signature & date Homeowner signature & date
r� CITY OF SALEM, NWSACH[;SEITS
�1J BUILDING DEPARTMENT
120 WASHLVGTON SHEET, 31O FLOOR
1 Y TEL (978) 145-9595
Rkx(978) 710.9846
Ki.\IBERL.EY DRISCOLL
N LA Y01 Inionfis sT.iamu8
DIQECTCR CF PUBLIC PROPERTY/8CIiDING CO\LNIISSIONER
Workers' Cumpensation Insurance AlTidavit: Iluilden/Contractors/Electrlcfans/PlumberI
li a slleant Information llea�se Prin Ugihl
.V cline lnmiitu?r Ur�]m7alio�^rLj�l�ndivitht,dl:
Address: �J37 fit L � f
cilylstataz(p: QAMbb Xfi 243 _ (home lk_ qlg .Et S—F�7ll
Are you an employer!Check the appropriate boss Type of project(required):
1.❑ I am a employer with 4. ❑ I am a suncral contractor and I S. 0 Now consulaction
21Kinrployees(fltll and/or part-time).• have hiroJ the sub.comneton
lain a sole proprietor or partner- listed oil the attachod.rheel i I. ❑Remodeling
?hip and have no employees These sub-contractors have I. 0 Demolition
working for me in any capacity. workers'comp,insurance. y, 0 Ouilding addition
INo wurkcts'comp. insurance 5. 0 We are a corporation W its
required.( officers have exercised their 10.0 Electrical n:pairs or additions
l.0 I am a homeowner doing all work right of uaelnptiun per MGL I I.0 Plumbing repuirs or udditions
myself,(\o workers'sump. C. 152, 11(4),and we have no 12.❑ Roof repairs
insurance required.) t omploy":$L (INC)workers' l5.❑Other
sump.insurance rcquireJ.)
11uy upplk:an tiW rhwkr but at meal atao till nut iha wawa Wow ahawina chair wcrkrm'rampanudun pulley inaumodaA
'I h.nvuwirw ,tho,ulmlif Ihis attlMvit indlorint they an,doing all�wrk and then him wili le rantmeram mlul mhmil a new allldaril indlaine suck$'�mrv:mn that rhv<k thin bw muar attuhud an l w&IJurwl.hMn lhuwine Iha nwna arihe mb.,,nlmekim A'd shelf wnrkm'ramp,pulley(nfamuu•e.
I tun an enpluyer rlrut Is pruvfdbill rvorktn'cumprnrarlun Lrsuruncefor my emp/uyrrs. Below IsrM pollry undJub sitein`oorrurlon.
In?unncc Company Name:__.....-._
Policy 9 or Selr-itu. Lic. N: Erpiratian Date:
Job Site Address: CilyiState/Zip;
\Inch a copy of the irorktrs' compensation pulley declaration PA0(showing the policy number and expiration data)
h'.Iiluru to wcurc cuvern,a is required under Suction 2JA ofblGL c. 152 can lead to the imposition of criminal penalties of s
tine up to S I,SUU.UO undlur mu-year impekarimcn4 ar Well as civil penakies in the forin cis STOP WORK ORDER and a line
of tqa na 5-''SQt10 s day gainer Ate viol.Itnr. Ile advixcd that o copy ul'Ihis?lalvinent may bu forwarJeJ to Ilse Oliiaa of
1.IeeNl gallUna it I I) A IOf ItllafLlte iOVCragC YQrilicatiun.
!Ju/rerrby r ni y r of du painr uuJ ptrinldr.r�a�perjury drur die iu/urnrwlon pruviJaJ buv iv uue wid currret
qZS 51s 41q 0 --- - rl
/�l/ieiv(rot�nJy, /7a rref ivrilr in dn:r errs, ro,St rump/�r✓J Sy rrcy ur ra wn.rj�lriul
City .ir 1'uwn: -. ,. -__ i'crmibl.lcenre i
t•tuin'�.\uthorily (circle nit); --._. - . .-.-
I. Itoafd ul llrallh !. Iluildlm� l)iy t.irhucut 1. l ily�'h nut Clerk 1. i•:Irctr L•al In gicc hir i. l'Inm6in;; Ilip,G. Ihhcr - r
In slits 0,rn ni is 1 hone h
CiTY OF S.u.E,ti[, �tiL1ss.1CFi(,'SETTS
JLMDLNG DEP.IRTtE\T
I '0 �OkiNNGTON 5rUgr, )�FLOOR
It+1. �97� 7�f•9S9f
K13 MERLBY OUXCLL Puc(973) 1149&4
MAYOR 1}OSW ST.PmxAS
0IUXT04 OP M SUC PROPIRTY/at:MDf.YG COS a,IS3t0S EA
Construction Debris DISPOI31 Atfidavit
(required for aU demolition and renovation work)
In accordance with the sixth edition Orthe State Building Code, 180 CMR section I 1 I.J
Debris, and the provisions of MGL a 40, S 54;
Building Permit b is issued with the condition that the debris resulting rmm
this work shall be disposed of in a properly licemed wrote dlsposGl facility as det?ncd by,�IGL c
11 I, S IJOA.
The debris will be transported by:
ST(L CG/i�57 (1Grll
The debris will be disposed Orin :
✓�lr2G�5 �5Po5�
�--
C�Zi��-a�wu rr1
(iddrets atrjcjhiy)
yn�niro,�rpermit ipplic�nt
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