183 OCEAN AVE - BUILDING INSPECTION T -1q3
Che Commonwealth of MassaehW
Board of Building Regulations and CS RVIGSra
CITY
dh
Massachusetts State Buildin
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Building Permit Application To Construct, Repair,Rpno�ate O�D�aQb$
One-or Two-Family D r G
This Section For Official Use Only
Building Permit Number. Date.'Applied
Building 0111621(Print Name). Signature . . Date
SECTION 1:SITE INFORMATION`
1.1 Pro a ty Address: 1.2 Assessors Map& Parcel Numbers
/ r DceCo-7 CA (--
I.I a Is this an acce led street?yes_ no Map Number Parcel Number
1.3 'Zoning Information: 1.4 Property Dimensions:
_ "Zoning District Proposed Use Lot Area(sq tt) Frontage(It)
1.5 Building Setbacks(R)
Front Yard - Side Yams Rear Yard
Required Provided Required Provided Required Provided
1.6 Water Supply:(M.O.L c.40,§54) 1.7 Flood Zone Information: 1.9 Sewage Disposal System:
Zone: Outside Flood Zone? Municipal m/n site disposal system ❑
Public EP/ Private O — Check if es❑ P po y
SECTION2: PROPERTY OWNERSHIP!'
2.1 Ownert of Record: 5 p �e2,y 4� l
Pc�el m�ehzh{v i �' 3
t7�1me(P'ay) City,State,ZIP
l g7 d Ge" .41.v 97 J9 2 74, — 4 73� 7
No.and Street Telephone Email Address
SECTION 3: DESCRIPTION OF PROPOSED WORK'(check all that apply)
New Construction O 1 Existing Building cKf Owner-Occupied 0 Repairs(s) 2j Alteration(s) ❑ Addition O
Demolition ❑ Accessory Bldg.❑ 1 Number of Units_ Other ❑ Specify:
Brief Description of Proposed Work': /2 e- P LC�-e ec K t rt6— ! n
h cw (f�7d ,ew
GL ';-COL
SECTION 4:ESTIMATED CONSTRUCTION COSTS
Item Estimated Costs: Official Use Only
Labor and Materials)
I. Building S J,6 o p 1. Building Permit Fee:S Indicate how fee is determined:
❑Standard City/Town Application Fee
2. Electrical S ❑Total Project Cost'(Item 6)x multiplier x
3. Plumbing S !%9ther Fees: S
d.Xlechanical (tIVAC) S List:
5.Mechanical (Fire 3 Total.\II Fees:S
Suppression)
Check No. Check Amount: Cash Amount:
6.Total Project Cost: .S 'MOOD ❑Paid in Full ❑Outstanding Balance Due:
MA<t
J
SECTION 5: CONSTRUCTION SERVICES
5.1 Construction Supervisor License'(CSL).
License Number Expiration Date
Name u(CSL Holder List CSL'rype(see below)
i
Type . , Description
No. ;tad Street __
U Unrestricted(Buildings tip to 35,000 cu. tt.)
R Restricted 1&2 Family Dwelling
City/Ibwn,State,ZIP hl Masonry
RC Roofina Covering
WS Window and Siding
SF Solid Fuel Burning Appliances
1 I Insulation
Telephone Entail address D Demolition
5.2 Registered Home Improvement Contractor(HIC)
HIC Registration Number Expiration Dale
HIC Comp:my Name or IIIC Registrant Name
No. and Street Email address
City/Town,State ZIP Telephone
SECTION 6:WORKERS'COMPENSATION INSURANCE AFFIDAVIT(M.G.L.F. 152.$ 2$C(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 Isivance of the building permit.
Signed Affidavit Attached? Yes ..........❑ No........... fi}/
SECTION 7o:OWNER AUTHORIZATION.TO BE COMPLETED WHEN,!
OWNER'S AGENT OR CONTRACTOR APPLIES FOR BUILDING PERIWIT
I,as Owner of the subject property,hereby authorize
t9 act on my behalf,in all matters relative to work authorized by this building permit application.
Print Owner's Nmne(Electronic Signature) Date
SECTION 7b:OWNEW ORAUTHORIZED AGENT DECLARATION
By entering my name below, 1 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 Authorized Agun s Name(Electronic Signature) Date
No•rEs:
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 1I.G.L.c. I42A.Other important information on the HIC Program can be found at
wvww mass ttov:'oca Information on the Construction Supervisor License can be found at www.ntass.,ov!dai .
2. When substantial work is planned,provide the information below:
'total fluor area(sq. ft.) '. .(including garage, finished basement/attics,decks or porch)
Gross living area(sq. R.) 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. "Ibtal Project Square Footage" may be.substituted Rr"Total Project Cost"
-� CITY OF SALEM, MASSACHUSETTS
BUILDING DEPARTMENT
120 WASHNGTON STREET,YD FLOOR
��ti�nso TEL. (97E) 745-9595
FAX(978) 740-9846
KIMBERLEY DRISCOLL
MAYOR TrIOMAS STTIERRE
DIRECTOR OF PUBLIC PROPERTY/BUILDING CONIXIISSIONER
r
HOMEOWNER LICENSE EXEMPTION
PLEASE PRINT:
Date
Job Location
i 83
Home Owner Address 5�Al Q
Present Mailing Address J a
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 �^"'
3
CITY OF SALEM MASSAC HUSE TTS
BUILDING DEPARTMENT
120WASHINGTON STREET,3mFLOOR
TEL. (978)745-9595
FAX(978)740-9846
KIMBERLEY DRISCOLL
MAYOR THomAs ST.PIERRE
DIRECTOR OF PUBLIC PROPERTY/BUILDING 00NMSSIONER
Construction Debris Disposal Affidavit
p
it
(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
condition that the debris resulting from this work shall be disposed of in a properly licensed
waste deposit facility as defined by MGL c 111, S 150A.
The debris will be transported by:
A0 / y-f-,
(name of hauler)
The debris will be disposed of in:
(name of facility)
(address of facility)
Signature of applicant
j r L04�
Dab
Commonwealth of Massachusetts
Citv of Salem
120 W ashington St,3rd Floor Salem,MA 01970(978)745-9595 x5641 .
Return card to Building Division for Certificate of Occupancy -
Permit No. B-14-1783
FEE PAID: $25.00 PEMF-xdvlvllT TO BRURILU
DATE ISSUED: 11/18/2014
This certifies that MUENZNER PETER S MUENZNER ROXANNE
has permission to erect, alter, or demolish a building 183 OCEAN AVENUE WEST Map/Lot: 240007-0
as follows: Renovation REPLACE!DECKING!IN FRONT ;NEW HANDRAILS ON 2ND FL PORCH & NEW
PELLET STOVE ON 3RD FLOOR
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Contractor Name: &,t (�
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DBA: `
Contractor License No: _ `s
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11/18/2014
v Building Official Date
This permit shall be deemed abandoned and invalid unless the work authorized by this permit is commenced within six months after issuance.The Building Official
may grant one or more extensions not to exceed six months each upon written request
All work authorized by this permit shall conform to the approved application and the approved constriction documents for which this permit has been granted.
i
All construction,alterations and changes of use of anybuilding and structures shall be in compliance with the local zoning by-laws and codes.
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This permit shall be displayed in a location clearly visible from access street or road and shall be maintained open for public inspection for the entire duration of the
work until the completion of the same. 5 '� ' Y y , h"
The Certificate of Occupancy will not be issued until all applicable signatures by the Building and Fire Officials are providedon thispermit.
,:r?�,"E o-3 ras. airy,
HIC#: Persons contracting with unregistered contractors do not have access to the guaranty fund"(as set forth in MGL c.142A).
Restrictions: {�� y:: _spa ` s� t ,t°`,�a"n °2y=
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Building plans are to be available on site.
All Permit Cards are the property of the PROPERTY OWNER.