13 PARLEE ST - BUILDING INSPECTION (3) GK Z.O l' ZS -
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rhe Commonwealth ofbiassachul"PECTIONAL SERV ES CITY OF
Board of Building Regulations and Standards SALEM
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Massachusetts State Building Code, 780�G�iR.OV 2 1 A & lsed Ll it 10//
Building Permit Application To Construct, Repair, RenoOv'aUteflflOr Demolish a
One-or Two-Faindy Dwelling
This Section For Official Use Only
Building Permit Number. Date Applied
V11—
II zl I
Building ORicial(Print N.une). SignatureD to
SECTION 1:SITE INFORNIATION'
Ll Property Address: 1.1 Assessors Diap&Parcel Numbers
t�gr ) t2Q S� �G(2M Mq
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 tl) Frontage(II)
1.5 Building Setbacks(R)
Front Yard Side Yams Rear Yard
Required Provided Required Provided Required Provided
[16 Water Supply:(M.G.L c.J0,§Sd) 1.7 Flood Zone Information: 1.9 Sewage Disposal System:
Zone: _ Outside Flood ZoneMunicipal❑ On sitedisposal system ❑
lic❑ Private❑ Chk iC es❑J.
SECTION Z: PROPE`RTY OWNERSHIP!' (�. rm 1fRet �nU JGtLx—V\/I �Ck / 7 O
F� me(Print) City,Stale,ZIP
}� TarIe-Q- S�_ 40 rVSw , COO
No.and Street Telephone Email Address
SECTION 3: DESCRIPTION OF PROPOSED WORK'(check all that apply)
New Construction Cl Existing Building❑ Owner-Occupied ❑ Repairs(s) ❑ Alteration(s) ❑ 1 Addition ❑
Demolition Cl Accessory Bldg.❑ 1 Number of Units_ I Other Cl Specify:
Brief Description of Proposed 1VorV:
=-5 -a, 4+/rof) � � S �_
\ w I I �1eT a>k
J� SECTION J: ESTIMATED CONSTRUCTION COSTS
Item Estimated Costs: Official Use Only
Labor and Materials)
I. Building S I. Building Permit Fee:$ Indicate how fee is determined:
❑Standard City/Town Application Fee
2. Electrical $ ❑Total Project Cost(item 6)x multiplier x
3. Plumbing $ !�,Qther Fees: S
d.Mechanical (FIVAC) $ List:
5. Mechanical (Fire S Total All Fees:$
Suppression)
Check No. Check Amount: Cash Amount".
6. Total Project Cost: I S .3500, 00 0 Paid in Full 0 Outstanding Balance Due:
SECTIONS: CONSTRUCTION SERVICES
5.1 Cunstruction Supervisor License(CSL)
I , ' ,l( License Number Expiration Date
Nmttc of CSL ilulder
List CSL'fype(see below)
No. and Street Type Description
U Unrestricted l3uildin s tip-to 35,000 cu. 11.
R Restricted I&2 F:unil Dwellin
Cityfrown,State,ZIP ivt Masonry
RC fooling Covering
WS Window and Siding
SF Solid Fuel Burning Appliances
1 I Insulation
Telephone Emoil address D Demolition
5.2 Registered Home Improvement Contractor(HIC)
HIC Registration Number F.xpirution Date
HIC Company Name or HIC Registrant Name
No. and Street Email address
Cityrrown,State ZIP Telephone
SECTION 6:WORKERS'COMPENSATION INSURANCE AFFIDAVIT(M.G.L.e. I52.§ 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........... O
SECTION 7a:OWNER AUTHORIZATION.TO BE COMPLETED WHEN.'
OWNER'S AGENT OR CONTRACTOR APPLIES FOR BUILDING PERMIT
1, 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 Name(Electronic Signature) Date
SECTION 7b:OWNEW OR AUTHORIZED AGENT DECLARATION
By entering my name below, I hereby attest under the pains and penalties of perjury that ail of the information
contained in this application is true and accurate to the best of my knowledge and understanding.
Print Owner's or Authorized Agent's Name(Electronic Signature) Date
NOTES:
I. A 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 rtaf have access to the arbitration
program or guaranty fund under M.G.L.c. I42A.Other important information on the HIC Program can be found at
www mass cov'out Information on the Construction Supervisor License can be round at%vww.mass.,ov!dL
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 hefting system Number of decks/porches
Type of cooling system Enclosed Open
3. "Total Project Square Footage"may be substituted fix"Tot:d Project Cost"
MORTGAGE INSPECTION
PLAN IN rtALPH
SALEM MASS. R`
} S.
No. 29422
REID LAND SURVEYORS �esuss
36 CCHATHAM ST., LYNN, MASS.
(781) 592-2660 — plotplans®reidls.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 Al CH. 40A SEC. 7.
/ N/F "'
/ THEOPHILOPOULOS
NF
DALEY // L.C. LOT 152
7400f SF
/
Q�v / SPLIT ENTRY Gc/
/ VINYL SIDED DECK ryh (u
GARAGE #13 cl)
// Ffn14E
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1DD.7s'
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13 PARLEE STREET Strcef
HEREBY, CERTIFY TO THE BEST OF MY KNOWLEDGE
THAT NE AREMISESLSHOWN ON HAZARD AREA THIS PLAN ARE
DELINEATED
ED WITHINNOTE: THIS PLAN WAS PREPARED FROM A
ON THE MAP Of ESSEX COUNTY PREPARED THE R I MORTGAGE PURPOSES ONLY TAPE SURVEY AND IS INTEN DOFFSE S SHOWN
SUCCESSORSDATED 7/6/2014. MAP
FEDERAL EMERGENCY
AGENCY O#25009C0 18G, ON OR SCALED FROM THS
ISHOULD, NOTE
PANEL NUMBER 418 OF 600, ZONE X . " APPROXIMATE ONLY AND BE
I FURTHER CERTIFY THAT THIS INSPECTION WAS PER— USED TO DETERMINE PROPERTY LINES.
FORMED IN ACCORDANCE WITH THE 'TECHNICAL STAND—
ARDS FOR MORTGAGE LOAN INSPECTIONS" AS ADOPTED SCALE: 1" = 20' DATE: SEP. 25, 2014
BY THE MASSACHUSETTS ASSOCIATION OF LAND SURVEYORS BOOK: PAGE: CERT.# 80062
9 AND CIVIL ENGINEERS.
THIS
FENCESCOR ERTIFDRIIIVEWAYS AS DOES
THEY DO NOT ALWAYNOT INCLUDE S INDICASTE CONTROL #:P14-0185 RR
PROPERTY LINES. PLL