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74 ORD ST - BUILDING INSPECTION The Commonwealth of Massachusetts Board of Building Regulations and Standards CITY OF Massachusetts State Building Code, 780 CNIR S Revised Mar N/nr 2011 Building Permit Application To Construct, Repair, Renovate Or Demolish a One-or Avo-Family Dwelling this Section For Official—Use Only Building Permit Number: ? Daf Applied.; Building Official(Print Name) Stgnatu SECTION f:SITE INFORNIA' 1.1 rgperty AeDddress: 1.2 Assessors Map& Parcel Numbers O I.I 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: / Zone: _ Outside Flood Zone? . / Public tg Private ❑ C Municipal<H On site disposal system ❑ Check if yes❑ SECT16N2: PROPERTY'OWNERSHH'i'`". 2.1 Owner'of Record: CArt s �z�hear t�7a yYc wt rr ✓o 57�, 1 etn, t k O l `1 70 Name(Print) City,State,ZIP 7y oAd, C_&-zLrj,,P" L' (°m rota t No. and Street Telephone Email Address SECTION 3: DESCRIPTION OF PROPOSED WORK' (check all that apply), New Construction ❑ Existing Building V Owner-Occupied 9( Repairs(s) 121' Alteration(s) 19" Addition ❑ Demolition 5r Accessory Bldg. Cl Number ofUnits___L_ Other ❑ Specify: Brief Des �ofposed Work': o - F1 no 2. Ab D Dot S h eoe 47rs7 w 5A e oP '�vrvt-re.v i vt �QGK SECTION 4: ESTIMATED CONSTRUCTION COSTS- Estimated Costs: Item Building i Official Only- Use Labor and Materials 1. Building S l02 r 1. g Permit Fee $ Indi1.cate how fee is determined: 2. Electrical ❑Standard CitylToim Application Fee �� ❑ "rota!Project Cose,(Item 6)x multiplier x 3. Plumbing S ,SD D 2. Other Fees: $. 4. Mechanical (FIVAC) $ pop List: i. Nechanical (Fire $ So : ression 'rota!All Fees: $ Check No. Check Amount•. Cash .\mount: (_ 'Total Project Cost: S f r7 6:0 6 ❑Paid in Full 0 Outstanding Balance Due: SECTION 5: CONSTRUCTION SERVICES 5.1 Construction Supervisor License(CSL) License Number Expiration Date Name ot'CSL Holder List CSL Type(sae below) No. and Street Type _ - Description U Unrestricted Buildin s up to 35,000 cu. rt. _ R Restricted 1&2 Famil Dwellin City/"ro%vn, State, LIP II ivfasonr RC Roofing Covering WS Window Lind Siding SF Solid Fuel Burning Appliances I Insulation 'relz hone Email address D Demolition 5.2 Registered Home Improvement Contractor(HIC) HIC Registration Number Expiration Date HIC Company Name or MC Registrant Name No. and Street Email address 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 .......... ❑ No ........... ❑ SECTION 7a: OWNER AUTHORIZATION TO BE COMPLETED WHEN OWNER'S AGENT OR CONTRACTOR APPLIES FOR BUILDING PERMIT [, 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. Print Owner's Name(Electronic Signature) Date SECTION 7b: OWNERI 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 applicatio is true and accurate to the best of my knowledge and understanding. 1-3// Print is or, u toured Agent o Name(Electronic Signature) Date NOTES: I. 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. I42A. Other important information on the H[C Program can be found at www.mass. oca Information on the Construction Supervisor License can be found at www.mass._ord 2. When Substantial work is planned, provide the information below-. Total floor area(sq. ft.) _(including garage, finished basement/atticS, decks or porch) Gross living area(sq. ft.) _ Habitable room count Number of fireplaces_ Number of bedrooms - _ — Number of bathrooms Number or half/baths rvpe orheating system _----- ---_.-- Number of decks/ porches ..... -- fypa of cooling systan— _--_--_--- Enclosed--- ------Open _ - - total I ro,ject Squ;ue Footage" may be substituted for"fund Project Cost" - -------------— -------- ------ -- ------------ CITY OF S.u.Eat PUBLIC PROPERTY DEPART"MENC u.a.a�a+r o•�•+• Vwry I b vA0YNCIOMlf7ap�SwK 4wwuaararn 01 f'0 rtiL 1'8.745.91"• t+..i 9?&7+O1)90 HOMEOWNER LICLNSB EXEM"10M PfeW Mat Date job Location �/ O/Z� 5T S'c—(em � MA 4/970 Home Owe Address I OAP sr Sa(� , Home Owns Telephone S S-S / Preaaot Mailing Address 7 it o eD s r ,Xf 4 ©/ 90 The current exemption of"Homeowners"was extended to include owner-occupied dwellings of two Units or teas and to allow such homeowners to engage an individual for hire who doom not possess a lic4mom provided that the owner acts as supervisor. DEMMON OF HOMEOWNER Person(s) who owns a pared offend on which he/she resides or intends to reside.on which then 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.+hall not boi considered a homeowner. Such "homeowner'shall subunit 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 PermiL The undersigned "homeowner"assumes reaponsibility for compliance with the State Building Code and other applicable bylaws 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 SIGNATURE .APPROVAL OF BUILDING NSPECTOR See other side for state code r/ O i i ��\wvvyvvvv�\ / O / Craig MCLam Sale: � 74 Ord St. Salem MA 01970 / 11 air l / / � O Craig Scale: 1 in=1 in 74 Ord St. Salem 01970 2x8 rafters EXISTING 2ND FL FRAME CROSS SECTION o 2x12 ridge � r W 12 2x10 rafter O 8 CQ G E Q 2x8 ceiling joist U) . m F v O It r` PROPOSED 2ND FL. FRAME CROSS SECTION 2 mWmW OUvS CITY OF SaUL E, . AxSSACHUSET TS BUIM04C DEPARTMENT ` r 130 WASHINGTON STREET, 3PD FLOOR TEL (978) 745-9595 Fmv(978) 740-9846 KIJt13ERLEY DRISCOLL +L�YOR THo.%W ST.PIERRS DIRECTOR OF PUBLIC PROPERTY/BCILDNG COM.,IISSIONER Construction Debris Disposal Affidavit (required for all demolition and renovation work) In accordance with the sixth edition of the State Buil ding Code 730 CMR section l t>; l .5 Debris, and the provisions of MGL c 40, 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 disposal facility as defined by MGL c 111, S 150A. The debris will be transported by: cat ss�( ( ge,- (name of hauler) The debris will be disposed of in (name of facility) (address of facility) signatur permit ap icant date dcbfc,.df,l.w