13 PARLEE ST - BUILDING INSPECTION (2) �35
The Commonwealth of Massachusetts
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 Officisk0se Only
Building Permit Number: Date pplied: 3
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Zjp.+n o
Building Official(Print Name) Signature ate n
SECTION 1:SI;TE INFORMATION -4
1.1 Propev Address: sessors Ma &Parcel tubers t
l3 /'IiRL£� S� 009CO41gG l t-00 7-0 "'
L la Is this an accepted street?yes no ap Number Parcel Number D m
1 `Zoning Information: 1.4�opet- 84mensions: Y 00 7c, ,y,� {
tt'�1 QQ I
Zoning District Proposed Use Lot Area(sq ft) Frontage(ft) "t
1.5 Building Setbacks(ft)
11-- Front Yard Side Yards Rear Yard
r1.6
equired Provided Requred Provided Required Provided
ater Supply:(M.O.L c.40,§54) 1.7 Flood Zone Information: 1.8 Sewage Disposal System:
❑ Private❑ Zone: _ Outside Flood Zone?
Check if yes❑ Municipal❑ On site disposal system ❑
/ SECTION 2: PROPERTY OWNERSHIP'
Owneri�hOY�of Record
lt— sx' ' ✓ ' M'+ 0/770
Name(Print) (yO City,State,ZIP
13 porlee Sf y7g-7YY-C/YrO raL� 15Otte- aQ i)
No.and Street Telephone Email Address
SECTION 3:DESCRIPTION OF PROPOSED WORK'(check all that appi)
New Construction❑ Existing Building❑ Owner-Occupied Repairs(s) ❑ Alteration(s) ❑ Addition ❑
Demolition ❑ Accessory Bldg.❑ Number of Unit Other ❑ Specify:
/ Brief tii of Pro osed Work':
V ri SSe
/ Ily 0 Qe h A OVC &rum sWrPniti vo ( ISO K z'4
SECTION 4:ESTIMATED CONSTRUCTION COSTS
Item Estimated Costs:
Labor and Materials Official Use Only
1.Building $ 1. Building Permit Fee:$ Indicate how fee is determined:
2.Electrical $ ❑Standard City/Town Application Fee
❑Total Project Cost'(Item 6)x multiplier x
3.Plumbing $ 2. Other Fees:.$
4.Mechanical (HVAC) $ List:
5.Mechanical (Fire
Su ression $ Total All Fees:$
r Check No. Check Amount: Cash Amount:
✓ 6.Total Project Cost: $ (�, �(�� ❑Paid in Full ❑Outstanding Balance Due: .
MAIC_ LoLA e-otjz;
SECTION 5: CONSTRUCTION SERVICES
5.1 Construction Supervisor License(CSL) I
License Number Expiration Date
Name of CSL Holder
List CSL Type(see below)
No.and Street Type Description
U Unrestricted(Building s up to 35,000 cu.ft.
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)
HIC Registration Number Expiration Date
HIC Company Name or HIC 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
I,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:OWNER' OR AUTHORIZED AGENT DECLARATION
IBy entering my name below,I hereby attest under the pains and penalties of perjury that all of the information
yV/ contained in this application is true and accurate to the best of my knowledge and understanding.
RMf10N9 -r- (-Ou S- 5- Z0/s-
Print Owner's or Authorized 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.govioca Information on the Construction Supervisor License can be found at www.nrass.eov/dos
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 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"
_i
MORTGAGE INSPECTION
PLAN IN RAL1
REID „.
SALEM, MASS. No. 20422
REID LAND SURVEYORS Gxo
365 CHATHAM ST., LYNN, MASS.
(781) 592-2660 — plotplans®reldls.com I CERTIFY THAT THE DWELLING IS LOCATED
AS SHOWN AND CONFORMED TO THE ZONING
SET BACK REQUIREMENTS OF THE CITY OF
SALEM WHEN CONSTRUCTED, OR IS
EXEMPT FROM VIOLATION ENFORCEMENT
UNDER M.G.L. TITLE VII CH. 40A SEC.
. 7._
6 N/F
THEOPHICOPOULOS
iS X N/
N/F �
/ OT 1
DALEY 7 F
4
SPLIT ENTRY U
VINYL SIDED
lo
GARAGE13#
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100.79'
13 PARLEE STREET
"I, HEREBY. CERTIFY TO THE BEST OF MY KNOWLEDGE
THAT THE PREMISES SHOWN ON THIS PLAN ARE NOT LOCAT— NOTE: THIS PLAN WAS PREPARED FROM A
ED WITHIN A SPECIAL FLOOD HAZARD AREA AS DELINEATED TAPE SURVEY AND IS INTENDED FOR
ON THE MAP OF ESSEX COUNTY PREPARED BY THE MORTGAGE PURPOSES ONLY. OFFSETS SHOWN
FEDERAL EMERGENCY MANAGEMENT AGENCY OR ITS ON OR SCALED FROM THIS PLAN, ARE
SUCCESSORS DATED 7/15/2014, MAP #25009C04180 APPROXIMATE ONLY AND SHOULD NOT BE
PANEL NUMBER OF 600, ZONE X . ' USED TO DETERMINE PROPERTY LINES.
I FURTHER CERTIFY THAT THIS INSPECTION WAS PER—
FORMED IN ACCORDANCE WITH THE -TECHNICAL STAND—
ARDS FOR MORTGAGE LOAN INSPECTIONS" AS ADOPTED
BY THE MASSACHUSETTS ASSOCIATION OF LAND SURVEYORS BOOK: PAGE: CERT.# 80062
AND CIVIL ENGINEERS.
THIS CERTIFICATION DOES NOT INCLUDE SHRUBS, WALLS, CONTROL #:P14-0185 RR
FENCES OR DRIVEWAYS AS THEY DO NOT ALWAYS INDICATE PILL LINES.
S