26 PICKMAN ST - BUILDING INSPECTION 6 30 0
The Commonwealth of Massachusetts INSF ECTIONAL
' Board of Building Regulations and Standards CITY
O
Massachusetts State Building Code,780 CMR lo' / of SALEM O
Building Permit Application To Construct, Repair,Renovate Or Demolish a
One-or Two-Family Dwelling
t ^ This Section For Official Use Only -
J Building Permit Number: ate Applied:
Building Official(Print Name) Signature =Date
SECTION 1:SITE INFORMATION
1 r per Address: 1.2 Assessors Map&Parcel Numbers
yk�tigwil ��r6J
(f\ Lla Is this an accepted street?yes no Nlap Numbcr Parcel Number
1.3 9nV Information• 1.4 Property Dimensions:
'fiw o 40,
0
Zoning District Proposed Use Lot Area(sq fi) Frontage(it)
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 7rone Information: 1.8 Sewage Disposal System:
Zone: tV`V'1 Outside Flood Zone?
Public'Ef Private❑ Check if yes❑ Municipal�!`On site disposal system ❑
SECTION 2: PROPERTY OWNERSHIP[ -
2. w err ofRe rd:
Name n (p ��fii > C City,State,ZIP
A � � 001 Spree Gt�u ( ( I A Zvker w6lG 6141 &VI/1
No.and Street Telephone Email Address
SECTION 3.DESCRIPTION OF PROPOSED WORK'(check-all that apply) ..,
New Construction❑ Existing Building 1� 1
Owner-Occupied ❑ Repairs(s) Alteration(s) g Addition ❑
Demolition 1$I 1 Accessory Bldg. ❑ Number of Units Other El Specify:
Brief Description of Proposed Work':
SECTION 4:ESTIMATED CONSTRUCTION COSTS
Estimated Costs: - -
Item -Official Use Only
(Labor and Materials
1.Building $ 1. Building Permit Fee:$ Indicate how fee is determined:
,,yy��
Q Standard City/Town Application Fee
2.Electrical $ 0 0 O ❑Total Project Cost'(item 6)x multiplier x
3. Plumbing $ y{ Q 0 Q 2. Other Fees: $_.
4. Mechanical (HVAC) $ -7 0 o List:__
5.Mechanical (Fire $ —
p Suppression) Total All Fees:$
Check No. Check Amount: Cash Amount:
7 6.Total Project Cost: $ n --
✓ D JI 9 ❑Paid in Full ❑ Outstanding Balance Due
6 (p3o l�ta�`� Ta (0> f06,4
SECTION 5: CONSTRUCTION SERVICES
5.1 Construction Supervisor License(CSL)
C�-o9�706 0� 0n ate
6
License Number Expiratio
Name of CSL Holder
List CSL Type(see below)
in Q-R o ve 1S TVZ� U
No.and Street Type Descriptions ,
U Unrestricted(Buildings up to 35,000 cu.ft.
l V R Restricted 1&2 Family Dwelling
City/Town,State,ZIP M —masonry
RC Roofing Covering
WS Window and Sidin
SF Solid Fuel Burning Appliances
91, S �1& 6 q 6 '5C F1w2ye 0N4Nm.c I Insulation
Telephone Email address D Demolition
5.2 Registered Home Improvement Contractor(HIC)
HIC Company Name or HIC Registrant Name ( IiIC Registration Number Expiration Date
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
1,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:OWNEW 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 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
m .mass.gov/oca Information on the Construction Supervisor License can be found at www.mass.eov/dps
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"
V
Work to be performed at 26 Pickman street:
Install new roof and skylights
Install 2 new decks railings and entry doors
Siding
Cathedral 3`d floor ceiling and remove existing illegal kitchen
Install new third floor bath
Renovate 2 new kitchens
Renovate 2 existing baths and install new laundry hook ups
Cosmetic repairs and improvements including refinish and install new floors, paint
Remove walls between kitchen and livingroom.
Install new closets
Install new heating system.
CITY OF S .F.M. NANSSACHUSETTS
BUU-DLNG DEPARTti1E2NT
• • 130 WASHNGTON STREET, 3w FLOOR
TEL (978) 745-9595
FAX(978) 740-9946
lCn,mi i R.Y DRISCOLL
MAYOR THODtAs 5T.PtERRs
DIRECTOR OF PUBLIC PROPERTY/BI'ILDLNG CONLNMIONER
Construction Debris Disposal Affidavit
(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 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:
(name of hauler)
The debris will be disposed of in :
(name of facility)
l
(address of facility)
V9 ture of permit applicant
date
debrisa(t:dw